Simple dacryops

Infantile simple dacryops: clinicopathological correlation and immunocharacterization

Simple dacryops is a cystic lesion of the ductal structures of the palpebral lobe of the lacrimal gland and is the commonest lacrimal ductal cystic lesion in adults. We report the case of an 18-month-old girl with a painless swelling of the right temporal upper eyelid that was first noted at 4 months of age. An early surgical excision was planned to avoid deprivational amblyopia. We describe clinicopathological and immunohistochemical correlations in our case, highlighting the immuno-characterization of adjacent lacrimal gland duct and acinar structures present within the cyst wall and management of this relatively rare entity.

Long-term Outcome of Incision and Curettage Treatment in Patients with Lacrimal Gland Ductulitis

Purpose

To describe the effects and long-term outcomes of incision and curettage treatment in patients with lacrimal gland ductulitis.

Methods

Twenty-four patients (24 eyes) with lacrimal gland ductulitis who were treated at Saevit Eye Hospital from June 2010 to November 2016. All patients underwent incision and curettage through the lacrimal ductule, and granules or concretions were removed. After the procedure, oral and topical antibiotics, oral anti-inflammatory agent were used for a week. Clinical presentations of the patients were analyzed. The resolution of symptoms and inflammatory signs and recurrence were evaluated more than 12 months after the procedure including telephone follow-up by a specialist nurse.

Results

Common symptoms were a painful, swelling mass with mucous discharge (17 eyes) and conjunctival injection (7 eyes) at the lateral canthal area. During the procedure, 22 patients (91.7%) had typical sulfur granule of Actinomyces, and 10 patients (41.7%) had many cilia in the expressed debris from the ductule. Twenty-three of 24 patients had resolution of symptoms after the procedure and all but one patient (95.8%) showed no recurrence.

Conclusions

Incision and curettage is a simple and less invasive procedure that may be considered as a first treatment option for lacrimal gland ductulitis. Furthermore, incision and curettage of the affected lacrimal ductule has been shown to be effective at minimizing long-term recurrence of lacrimal ductulitis.

Giant Bilateral Cysts of the Accessory Lacrimal Glands of Wolfring in a Child

Ductal cysts of the accessory lacrimal glands of Wolfring are rare clinical entities. They typically present as mobile and translucent lesions on the superior or inferior tarsal borders. Here, the authors describe a 7-year-old male child presenting with giant bilateral cysts of Wolfring. Management of such cysts is primarily surgical and the preferred route for excision is transconjunctival. To the best of the authors' knowledge, this is the first report of a bilateral Wolfring dacryops affecting a child.Cysts of the accessory lacrimal glands of Wolfring are rare clinical entities. To the authors' knowledge, here the authors describe the first report of a bilateral Wolfring dacryops affecting a child.

Accessory lacrimal gland duct cyst: 23 years of experience in the Saudi population

BACKGROUND AND OBJECTIVES

Accessory lacrimal gland ductal cyst is a rare clinical entity that has been reported after trauma, infection, or conjunctival inflammation. Trachoma has been postulated as an etiologic factor for this dacryops in Saudis. We studied the prevalence, demographics, clinicopathological features and surgical approach for these lesions.

DESIGN AND SETTING

Retrospective study of 23 consecutive ductal cysts diagnosed clinically and proved histopathologically at King Khaled Eye Specialist Hospital (KKESH) over 23 years (1991-2014).

PATIENTS AND METHODS

Data on patient demographics, clinical features, surgery, and outcome were collected by chart review. The histopathologic slides were reviewed by a single pathologist.

RESULTS

Of 23 cases of accessory lacrimal gland ductal cysts confirmed histopathologically, 14 were males and 9 females with a median age of 38.8 years. Cysts were located in the upper eyelid in 73.9%. The commonest presentation was a painless eyelid mass in 91.3%. Excision by conjunctival incision was performed in 14 and intra-operative perforation occurred in 9. Trachomatous scarring was evident in 39.1% but did not have significance in relation to this rupture. No recurrences have been observed with a mean follow up of 34.6 months.

CONCLUSION

The approximate prevalence of accessory lacrimal gland dacryops in the Saudi population is 1/6800. Trachoma does not seem to be a major predisposing factor. They are more frequent in males. Their histopathological appearance is identical regardless of origin. The presence of conjunctival scarring, dacryops size, and the surgical incision type did not seem to have significant correlation with the iatrogenic rupture of the cyst. We recommend careful dissection for complete cyst excision through conjunctival approach with no expected recurrence.

The cytologic composition of dacryops: an immunohistochemical investigation of 15 lesions compared to the normal lacrimal gland

PURPOSE

To define the cytologic composition of the double-layered epithelial lining of dacryops (lacrimal duct cyst), improve histopathologic diagnosis, and better understand pathogenesis.

DESIGN

Clinicopathologic retrospective study with immunohistochemical studies of 15 lesions compared with normal lacrimal gland.

METHODS

Clinical data from 14 patients were reviewed and microscopy was performed with routine stains and immunohistochemical probes for epithelial membrane antigen (EMA), gross cystic disease fluid protein-15 (GCDFP-15), cytokeratin 7 (CK7), and smooth muscle actin (SMA).

RESULTS

The major lacrimal gland was involved in 13 lesions; 2 lesions arose in an accessory gland of Krause. One case was bilateral; the average age of the patients was 50.7 years. Neither visual acuity nor motility was disturbed. No lesion was discovered to have recurred after excision. Microscopically, in all dacryops specimens goblet cells and luminal pseudoapocrine apical cytoplasmic projections were identified. Lacrimal acinar cells immunoreacted with GCDFP-15 and CK7, whereas the normal ducts and the epithelium of the dacryops lesions reacted diffusely only with CK7. SMA-positive myoepithelial cells were found in the acini but not in the normal ducts or dacryops epithelium.

CONCLUSIONS

Negative GCDFP-15 staining ruled out apocrine metaplasia in dacryops. Normal ducts and dacryops showed no immunohistochemical evidence for the presence of myoepithelial cells. Pathogenetic theories of dacryops that implicate a failure of ductular "neuromuscular" contractility must therefore be revised. A dysfunction of the rich neural plexus around the ductules may play a role in the development of dacryops in conjunction with periductular inflammation and induced scarring.

Case report: bilateral lacrimal gland enlargement: an unusual manifestation of dacryops

Dacryops is an uncommon condition and, because it is usually obvious clinically, patients rarely come to radiological investigation. However, it is important for the radiologist to consider this condition in the differential diagnosis of lacrimal gland swelling and therefore to look for a cystic component in the lesion. We present such a case and review the literature on this condition.

Lacrimal gland ductule stones

Chronic unilateral conjunctivitis may be caused by various infectious, inflammatory, neoplastic, or mechanical conditions. Two patients with persistent unilateral conjunctivitis were cured after removal of dacryoliths from the palpebral lobe of the ipsilateral lacrimal gland. Although lacrimal gland ductular dacryoliths are rare, this entity should be included in the differential diagnosis of chronic unilateral conjunctivitis.

Lacrimal ductal cysts

Cyst formation can occur in any location where lacrimal gland tissue is present. A new classification is proposed based on these locations: palpebral lobe cysts (simple dacryops); orbital lobe cysts; cysts of the accessory lacrimal glands of Krause and Wolfring; and cysts of ectopic (choristomatous) lacrimal glands. The characteristic clinical presentation, histopathology, and treatment of these lacrimal ductal cysts is described.

Lacrimal ductal cysts. Presentation and management

The authors have reviewed the clinical and histopathologic features of nine cases of lacrimal ductal cysts. Six of these were proven histologically, and three were diagnosed clinically. All presented as masses, three with pain, five with tenderness and two with acute expansion due to hemorrhage in one case and following crying and deep sea diving in the other. Six were treated surgically and three are being followed clinically. The six lesions examined histologically were all ductal cysts with evidence of scarring and inflammation. The differential diagnosis and management are outlined.

Orbital dacryops

Two patients presented with an enlarging orbital mass that proved to be simple dacryops, a condition in which a cyst arises in the palpebral lobe of the lacrimal gland. The cyst in one patient was lined by one to two layers of relatively flat epithelial cells favoring a lacrimal gland ductal origin. In the second patient, the cyst was lined by a nonkeratinized stratified squamous epithelium with numerous goblet cells consistent with a conjunctival origin.

Caruncular dacryops with extruded secretory globoid bodies

A 52-year-old black man evaluated for a left cataract following an iritis was incidentally noted to have a vascularized, firm, inflammatory-appearing left caruncular mass. Removal of the cataract and of the left caruncular mass led to the discovery that the latter was composed of dilated channels containing secretory globoid bodies; the cyst wall was composed of a double layer of cuboidal epithelium, occasionally displaying apical cytoplasmic snouts. Lobules of lacrimal gland tissue were found in intimate association with the cystic spaces in multiple foci. The secretory globoid bodies had ruptured from the cystic cavity into the connective tissue of the caruncle, where a multinucleated foreign body-type granulomatous response had been elicited. This spontaneous rupture and the ensuing inflammation accounted for the inflammatory character of the lesion on clinical examination. The authors believe that secretory globoid bodies are a distinctive feature of dacryops, which normally occurs in the major lacrimal gland. When dacryops occurs in a minor lacrimal gland of the caruncle or fornices (glands of Krause or Wolfring), the presence of secretory globoid bodies may help to distinguish dacryops in these unusual locations from small conjunctival inclusion cysts, which sometimes have calcareous inclusions but lack the myriad spherical secretory bodies of dacryops.