Conjunctival orbital cyst

Dumbbell-Shaped Congenital Conjunctival Cyst of the Orbit

Congenital conjunctival cysts often occur in the medial orbit without adjacent bone destruction and have not been previously reported in a dumbbell configuration. A 46-year-old female patient presented with left proptosis and headache. A radiological study revealed a large, cystic, bilobed mass in the orbital-temporal area with an osseous defect in the lateral wall. A histological examination of the excised lesion showed that the cyst wall consisted of non-keratinized stratified epithelium with goblet cells. There was no recurrence during the follow-up. Of the previously reported 54 cases, only 1 had bone erosion due to a recurrent cyst in the frontal bone. Although rare, a primary conjunctival cyst can create a dumbbell-shaped lesion in the lateral orbit and temporal fossa.

Congenital Conjunctival Cysts of the Orbit

PURPOSE

To evaluate the clinical presentation, anatomical location, and histological features of congenital conjunctival cysts of the orbit. The location and the histological features of inflammation in these patients were compared with those for 293 orbital dermoid cysts.

PATIENTS AND METHODS

Retrospective review of the clinical details, imaging, and histopathology for patients who had excision of conjunctival cysts from their orbit between 1992 and 2020; patients with a history of trauma or surgery were omitted.

RESULTS

Twelve patients (7 male; 58%) with congenital conjunctival cysts were identified, the patients presenting at an average age of 16 years (median 26; range 1-61) with a symptoms for a mean duration of 20 months (median 24; range 6-36). The commonest symptoms were peribulbar lump (6/12 patients; 50%), and eyelid swelling and blepharoptosis (6/12 patients; 50%). An orbitaxl mass was palpable in 10 patients (83%), 3 patients (25%) had mild proptosis (1-3 mm), and the cysts were most commonly located superiorly (6/12 patients; 50%) or superonasally (3/12; 25%) in the anterior half of the orbit. Imaging was performed in 7 cases, this showing an intimate relation to the common sheath of the superior rectus/levator complex in 3 patients (25%) and to the trochlea in 1 (8%). All cysts were excised completely, and no patient had postoperative complications or recurrence. Chronic mild and nonspecific inflammation was evident within the cyst wall in 7 cases (54%), but-unlike 55% of the 293 dermoid cysts-none showed granuloma formation.

CONCLUSION

Congenital conjunctival cysts are rare and usually present with a palpable mass in the upper eyelid sulcus. A significant proportion of these cysts have an intimate relationship with the trochlea, or the superior rectus, levator palpebrae or superior oblique muscles and, to minimize the risk of postoperative diplopia or ptosis, particular care must be exercised during surgery.

Clinical study of histologically proven conjunctival cysts

Purpose

This is a clinco-histopathological study of different varieties of conjunctival cysts where modification of surgical technique was done as per requirement for intact removal of cysts to minimise recurrence rate.

Materials and methods

Retrospective study of 40 cases of conjunctival cysts. A thorough ocular examination and basic haematological work up was done for all patients. B-scan USG and MRI was done wherever required to see the posterior extent. All patients underwent surgical excision of cyst followed by histo-pathological examination.

Results

The various types of conjunctival cysts found in our study were primary inclusion cyst 12 (30%), secondary inclusion cyst 6 (15%), pterygium with cysts 15 (37.5%), parasitic cyst 4 (10%), lymphatic cyst 2 (5%), and orbital cyst with rudimentary eye 1 (2.5%). The common symptoms noted were progressive increase in size of cyst (39.45%), cosmetic disfigurement (26.23%), foreign body sensations (27.86%), proptosis (1.6%), ocular motility restrictions (3.2%) and decreased visual acuity (1.6%). The patients were followed till one year after surgical excision for any recurrence and complications and no recurrence was seen.

Conclusion

Careful and intact removal of conjunctival cyst is important to prevent recurrence. Minor modifications in surgical technique according to the size, site and nature of cyst help in intact removal and prevent recurrence.

Orbital giant conjunctival epithelial primary cyst

CASE REPORT

A 15-year-old male, with no previous traumatic o surgical ocular injury, presented with a right eye proptosis and inferior displacement which began 4 months earlier. Ultrasound and CT showed a cystic lesion of 3.5 × 2 cm in the superior orbit. Surgical resection was performed by transconjunctival orbitotomy. The histopathology examination showed a cyst with nonkeratinized epithelium, and without goblet cells. After 10 years of follow-up, there have been no new lesions.

DISCUSSION

Conjunctival primary orbital cysts are very uncommon. They are usually of small-moderate size; giant cysts are exceptional. Diagnosis by imaging is essential to establish the differential diagnosis and surgical treatment.

Primary conjunctival epithelial cyst of the orbit

BACKGROUND

A primary conjunctival epithelial cyst is an uncommon lesion that consists of nonkeratized, stratified squamous epithelium without dermal appendages.

METHODS

Case report.

RESULTS

A 57-year-old woman presented with a soft mass in the anterior portion of the nasal orbit. Magnetic resonance imaging demonstrated a rounded, cystic lesion between the right eye and the nasal bone. Histopathological examination following complete surgical excision disclosed a conjunctival epithelial cyst lined by nonkeratinized cuboidal epithelium without goblet cells and adnexal structures.

CONCLUSION

A conjunctival epithelial cyst should be considered in the differential diagnosis of a mass in the anterior portion of nasal or superonasal orbit.

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.

Atypical choristomatous cysts of the orbit

BACKGROUND

The commonset choristomatous cysts of the orbit are dermoid and epidermoid cysts, which are lined by kerantinizing squamous epithelium. They typically occur in the superior orbit, most commonly superotemporally. Other types, lined by different epithelia, and other orbital sites are much less common.

METHODS

Five cases of atypical orbita cystic choristomas that presented over the past 6 years are reported. The clinical and radiological features, surgical approach and findings, and histology, are described. Similar cases from the literature are reviewed and possible aetiology discussed.

RESULTS

Four of the cysts were lined by a non-keratinizing epithelium resembling conjunctiva; two had adnexal structures in their walls. Compared with typical dermoid and epidermoid cysts, these 'conjunctival dermoids' and 'conjunctival cysts' of the orbit tended to present later in life, none were associated with bony defects, and three of the four occurred in the superomedial quadrant. One case occurred inferiorly, a rare site for orbital conjunctival dermoids and cysts, or typical dermoids and epidermoids. The fifth case, also inferior, is an example of a cyst within choristomatous lacrimal tissue.

CONCLUSION

Choristomatous cysts of the orbit may occur with non-keratinizing epithelial linings, and such cysts tend to differ clinically from the commoner dermoids and epidermoids. They may also occur in atypical sites such as the inferior orbit.