Orbital dacryops

An Unusual Case of Lacrimal Gland Dacryops in a 10-Year-Old Child

Lacrimal gland dacryops are an unusual type of benign epithelial neoplasm. Most of the literature refers to dacryops of the lacrimal palpebral lobe, with orbital lobe involvement less frequent. The authors report a case of dacryops in a 10-year-old child involving the orbital lobe of the lacrimal gland. [J Pediatr Ophthalmol Strabismus. 2023;60(6):e79-e82.].

Dacryops of the lacrimal gland in an elderly woman: A case report

INTRODUCTION

Dacryops is a rare benign cystic lesion of the lacrimal gland often developing in the palpebral gland. The exact etiology of dacryops remains unclear. Diagnosis could be suspected clinically and established histopathologically. Treatment is commonly surgical.

PRESENTATION OF CASE

We report the case of a 75-year-old woman with past history of total conservative parotidectomy for a benign tumor 10 years ago. She presented to the Ophtalmology Department at Farhat Hached University Hospital of Sousse with a painful swelling of the left supero-external orbital angle. The patient underwent complete excision of the cyst using the conjunctival approach. Histopathological examination showed characteristic features of dacryops with foci of chronic inflammatory cell infiltrates.

DISCUSSION

Dacryops is commonly seen in young adults or middle-aged individuals with a slight female preponderance. In some cases, cystic enlargement of dacryops can lead to mechanical ptosis, dystopia, limitation of extraocular movements, diplopia, and, in rare cases, blepharoptosis. However in this case, the patient was an elderly woman presenting a painless mass without ptosis. As in our case, excision using the conjunctival approach under microscope has excellent results without complications. Histopathological examination confirms the diagnosis and helps to rule out differential diagnoses.

CONCLUSION

As reported in the present case, histopathological examination confirms clinically recognized or suspected dacryops. If untreated, dacryops may lead to ptosis, proptosis and/or dystopia. Complete excision of the cyst is often curative.

Lacrimal Gland Ductal Cyst Complicated by Abscess Formation

A 52-year-old woman with a 7-month history of a left lateral upper eyelid nodule presented with an acute, 1-day history of left upper eyelid swelling and erythema associated with chemosis, epiphora, and pain. Magnetic resonance (MR) imaging revealed a well-circumscribed cystic mass indistinguishable from the left lacrimal gland containing a fluid-fluid level. Surgery confirmed an abscess within the lacrimal gland; histopathologic examination revealed a dilated lacrimal duct with an inflammatory exudate within the lumen. This report details one of the few reported cases of an acute lacrimal gland ductal cyst abscess and, to the authors' knowledge, the first with MR images.

Lacrimal ductal cyst of the medial orbit: a case report

Background

The lacrimal ductal cyst (dacryops) is an uncommon clinical entity. It occurs anywhere that lacrimal gland tissue is present but most often appears as an expanding mass in the region of the lacrimal gland. The presence involving the medial part of the orbit is rare, ectopic location can be misleading in the differential diagnosis of orbital masses. The authors report a 53-year-old man who presented with dacryops occurred in an unusual location with significant clinical presentations.

Case presentation

A 53-year-old man had a painless mass located in the right superomedial orbit accompanied with foreign body sensation and lachrymation for two months, which had rapidly grown within 10 days. Decrease of visual acuity, high intraocular pressure (IOP) and limitation of extraocular movements in the right eye were present. The result of visual evoked potential (VEP) test suggested the impaired function of the optic nerve. Magnetic resonance imaging (MRI) studies revealed the presence of an isolated cystic lesion. The mass was completely removed via a transcutaneous approach, histopathologic findings were consistent with the lacrimal ductal cyst. The ocular motility and high IOP returned to normal. There had been no post-operative complications or signs of recurrence over five months follow-up.

Conclusion

Lacrimal ductal cysts can present in the medial orbit, clinicians should include this entity in the differential diagnosis of orbital masses and be aware of its variable presentations such as high IOP in this case. We comment on the fact that many reported cases of ectopic dacryops may be an extension of normal lacrimal gland tissue.

Dacryops - A review

Purpose: To review and summarize the epidemiology, clinical presentations, histopathologic characteristics and management of dacryops.Methods: A comprehensive PubMed, Embase and Google Scholar search of all articles written in English and non-English language articles with abstract translated to English on dacryops were reviewed. Data reviewed included epidemiology, etiology, pathogenesis, clinical presentations, histopathologic characteristics and management of dacryops.Results: Lacrimal ductal cysts or dacryops are classified based on 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 exact etiology of dacryops remains unknown. Dacryops is usually asymptomatic but can present with varied symptoms depending on the type and associated complications. While complete excision of dacryops is generally recommended, marsupialization is also a safe and effective method for the treatment of dacryops in the palpebral lobe of lacrimal gland. Complete surgical excision via orbitotomy is required for deep orbital lesions.Conclusion: Dacryops is an uncommon benign cystic lacrimal gland tissue neoplasm. Dacryops can be classified into four types based on locations. Lesions could be either superficial that can be seen through the fornix or deep into the orbit. Observation is also an option for small or asymptomatic lesions. Surgery remains the mainstay of treatment for symptomatic cases, but approaches are different depending on the location of the lesions.

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.

The role of entrapped cilia on the formation of lacrimal ductular cysts

PURPOSE

We sought to describe the histopathologic features of lacrimal ductular cysts with or without inflammation and speculate on the role of cilia in their pathogenesis.

MATERIALS AND METHODS

A retrospective study of 15 patients referred for lateral canthal subconjunctival cysts from 2001 to 2012 was conducted. All patients underwent cyst removal and a total histopathological examination was done. Patients were classified into 2 groups and analyzed according to their clinical and histopathologic characteristics.

RESULTS

Fourteen showed unilateral disease and one had bilateral disease, with a mean age of 42.8 years. Six patients had mild discomfort or no symptoms, and the remaining 9 of 15 patients presented with a symptomatic mass with conjunctival discharge and injection. Two layers of ductal epithelium constituted the whole wall of the cyst in the seven non-inflammatory cysts, three of which showed cilia in the lumen. The presence of stratified columnar epithelium with goblet cells was a peculiar feature in the lining of the nine inflammatory cases, seven of which showed cilia shafts with inflammatory cells and concrete material in the lumen. Pilosebaceous units were not evident in any of the specimens on pathologic examination.

CONCLUSION

Cilia entrapped in the lacrimal ductule may play a role in the formation of lacrimal ductular cysts with or without inflammation. Cilia falling from the eyelid may be caught in the conjunctival fornix then shift toward the horizontal lacrimal ductule in the lateral canthus. It may then serve as a nidus to provoke lacrimal ductular inflammation or cyst formation.

Clinicopathological features of inflammatory lesions of the lateral canthal subconjunctival area

PURPOSE

To investigate the clinical and histopathological features of inflammatory lesions of the lateral canthal subconjunctival area.

METHODS

This is a retrospective case series of 12 patients with inflammatory subconjunctival masses in the lateral canthal area. All patients included in this study were treated at Seoul National University Hospital or Seoul National University Bundang Hospital between 2006 and 2012. Clinical data were obtained from the medical records. Histopathologic findings were thoroughly reviewed.

RESULTS

There was a woman predominance in the study group (10:2), and the median age at presentation was 39 years (range 33-70). Common symptoms included conjunctival injection, sticky discharge, and pain or discomfort. Histopathologically, all lesions originated from ductules of the lacrimal gland. Two cases showed cysts containing clear fluid with mild inflammation. One case showed lacrimal ductulitis without cyst formation. Nine cases showed lacrimal ductal cysts with varying periductal inflammation, and the contents were pinkish, amorphous materials in 7 cases. Embedded cilia were found in 8 cases.

CONCLUSIONS

Inflammatory lesions of the lateral canthal subconjunctival area all originated from lacrimal gland ductules, showing a variable histopathologic spectrum of inflammation and cyst formation. Cilia impaction was a very frequently observed finding.

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.

Apocrine secretion in lacrimal gland cysts (dacryops): a common but underrecognized phenomenon

We present six cases (five females, one male; aged 26-81 years) of dacryops, also known as lacrimal gland cyst, all of which occurred at the outer canthal area below the upper eyelid. All presented clinically as a painless cystic lesion that was white to blue in color. Microscopically, in addition to typical features of dacryops, which is characterized by a partially cystic proliferation that includes a double layer of columnar to cuboidal epithelial cells associated with lobules of lacrimal gland tissue, we identified evidence of apocrine secretion (i.e. apical snouts projecting into the lumen), either in the cystic component of the proliferation or in contiguous lacrimal duct, in all cases. One example was unusual. It manifested, in addition to typical cyst formation, with areas of ductal and probably acinar hyperplasia. We conclude that apocrine secretion in dacryops is a common and underrecognized phenomenon. Dacryops should be distinguished from apocrine hidrocystoma, a lesion commonly encountered in the periorbital area in the practice of dermatopathology.

Complex palpebral odontogenic choristoma: A reappraisal of the origin of teeth-bearing periocular lesions

PURPOSE

To describe the findings observed in a congenital ectopic tooth of the lower inner eyelid and explain its origin.

DESIGN

Retrospective and interventional clinicopathologic study.

METHODS

Histopathologic evaluation of sequentially excised specimens over 4 years and radiographic study of any associated dental abnormalities, compared with critical reevaluation of similar reported cases in the literature.

RESULTS

The ectopic eyelid tooth clinically created a dome-shaped mass and microscopically displayed advanced cytodifferentiation but incomplete morphogenesis with clearly identifiable ameloblasts, enamel, odontoblasts, and dentin, surrounded by an intact dental sac. Swollen oral mucosal epithelium with associated sebaceous Fordyce nodules, residual ciliated odontogenic epithelium, embryonic epithelial rests, and accessory mucinous and sero-mucinous accessory salivary glands were discovered in place of normal conjunctiva. The tarsus with meibomian glands was absent but islands of cartilage were present.

CONCLUSIONS

Because of the variety of the ectopic tissues that were exhibited, a causative displacement of oral embryonic epithelium with extensive differentiating potentialities is posited. Two previously reported palpebral dental choristomas also had identical locations in the inferomedial eyelid. This is the site where the phakomatous choristoma may be encountered, but this unencapsulated mass creates an eyelid thickening without a globoid configuration and infiltrates the inferior orbit. After a careful re-appraisal of published reports of orbital cysts bearing a tooth that were formerly diagnosed as "teratomas," we have concluded that they developed from similar embryonic oral (buccal) epithelial displacements rather than from aberrant germ cells, based on the cysts' linings and the associated accessory salivary glands in their walls. This view is further supported by the absence of heterologous teratomatous elements of endodermal or neuroectodermal derivation. A clinical and surgical approach to management and a new diagnostic schema for odontogenic choristomas are proposed.

Conjunctival cysts of the orbit

OBJECTIVE

This study reviews functionally and anatomically disruptive features of simple conjunctival orbital cysts.

DESIGN

A case series review from four oculoplastic practices over 6 years.

PARTICIPANTS

Eleven patients with simple conjunctival cysts of the orbit were identified.

INTERVENTION

All cysts were excised and evaluated histopathologically.

MAIN OUTCOME MEASURES

Assessment was made of the length of time from inciting event to presentation, preoperative and postoperative refractive state and ocular motility, the presence or absence of discomfort, and radiographic or clinical evidence of bone remodeling.

RESULTS

Six of 11 cysts were presumed to be primary, unrelated to antecedent surgery or trauma. Four of 11 cysts were associated with pain or tenderness, 5 cysts induced ocular motility disturbance, 6 cysts caused observable globe distortion or refractive error change, and 6 cysts remodeled bone.

CONCLUSIONS

Simple conjunctival cysts of the orbit, traditionally regarded as low-pressure lesions with minimal structural impact, may induce considerable anatomic and functional disruption.

Orbital lobe lacrimal ductal cyst

Lacrimal ductal cysts are rare, especially in the orbit. A case of lacrimal ductal cyst in the orbital lobe, revealed by computed tomography and magnetic resonance imaging, is described in a 16-year-old man who was successfully treated by complete surgical excision. The radiologic and clinical features of this type of lacrimal ductal cyst are discussed.

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.

Canaliculops

Over a 1-year period, a cystic bluish coloration developed in the most medial aspect at the margin of the right upper eyelid of a 40-year-old man. The clinical diagnoses were either a conjunctival inclusion cyst or an adnexal cyst, possibly of the gland of Moll. The excised specimen was studied histopathologically and exhibited a lining that was virtually indistinguishable from that of the normal canaliculus, except for hyperplasia of the cellular wall and the focal presence of a superficial mucin-producing columnar cell monolayer at the lumen. The medial edge of the excised specimen showed a merging of the cyst into a nonectatic portion of the canaliculus. Inflammation in the wall of the cyst and in this terminal portion of the canaliculus was not identified. This is believed to be a unique entity of an idiopathic ectasia with mild epithelial proliferation of a segment of the canaliculus. The authors have termed this condition canaliculops, to draw a parallel between it and ectasia of the ducts of the lacrimal gland, so-called dacryops.

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 gland choristoma of the ciliary body

A 22-month-old girl was found to have a pigmented mass of the ciliary body of the right eye. Five months later the globe was enucleated because of enlargement of the tumor and the appearance of brown pigment on the adjacent epibulbar surface. Histopathologic examination disclosed a lacrimal gland choristoma of the ciliary body with involvement of the limbal conjunctival surface and superficial sclera. Choristomas of the lacrimal gland are rare and only eight cases have been reported previously to occur intraocularly. Most of these cases showed extrascleral involvement which suggests that the anlage for these choristomas may be entrapped intraocularly during the development of the globe. We recommend conservative management, either by observation or local resection if possible.