1
|
Diab MM, Allen RC, Mohammed KK, Saif ATS. Clinical characteristics and surgical outcomes of transcutaneous versus transconjunctival excision of Wolfring gland ductal cysts. BMC Ophthalmol 2024; 24:164. [PMID: 38622551 PMCID: PMC11020823 DOI: 10.1186/s12886-024-03420-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/30/2024] [Indexed: 04/17/2024] Open
Abstract
PURPOSE To analyze the clinicopathological characteristics and surgical outcomes of patients with Wolfring gland ductal cysts (WGDCs). METHODS A retrospective, consecutive, interventional comparative case series was performed over a period of 7 years. Data on demographic and clinical characteristics, pathological findings and outcomes of surgically excised cysts were collected. A comparison between the transconjunctival and transcutaneous approaches was also assessed. RESULTS Forty-eight patients (48 eyelids) were included in the final analysis. The most common presenting symptom was painless eyelid swelling (81.3%). The median symptom duration was 11.5 months (IQR, 18.25). The upper eyelid was involved in 31 (64.6%) patients, 29/31 of whom had cysts in a medial or centromedial location. Forty-five (93.8%) cysts were bluish gray and transilluminable with clear contents on lid eversion and a median largest dimension of 22 mm (IQR, 8). A transverse conjunctival fibrotic band was observed along the proximal tarsal border in the cyst area in all patients. Signs of chronic trachoma were noted in 38 (79.2%) patients. Preoperative significant ptosis was present in 28/31 (90.3%) of the upper eyelid cysts. Thirty cysts (62.5%) were excised through the skin, and 18 cysts (37.5%) were excised transconjunctivally. Intraoperative cyst rupture, the need for conjunctival grafting and postoperative residual upper lid ptosis were significantly greater in the transconjunctival group (p = 0.009, p < 0.001, and p = 0.016, respectively). CONCLUSION The present study highlights the clinicopathological characteristics of a relatively large series of surgically excised WGDCs. Transcutaneous excision of WGDCs has proven to be an effective treatment with fewer adverse sequelae than the transconjunctival approach.
Collapse
Affiliation(s)
- Mostafa Mohamed Diab
- Dept. of Ophthalmology, Faculty of Medicine, Fayoum University, 6 Elnabawy St, Borg Al Atebbaa, Al Mesalla, 63514, Al Fayoum, Egypt.
| | - Richard C Allen
- Dept. of Ophthalmology, Dell Medical School, University of Texas at Austin, Texas Oculoplastics Consultants, Austin, TX, USA
| | - Khaled Kotb Mohammed
- Dept. of Ophthalmology, Faculty of Medicine, Fayoum University, 6 Elnabawy St, Borg Al Atebbaa, Al Mesalla, 63514, Al Fayoum, Egypt
| | - Ahmed T S Saif
- Dept. of Ophthalmology, Faculty of Medicine, Fayoum University, 6 Elnabawy St, Borg Al Atebbaa, Al Mesalla, 63514, Al Fayoum, Egypt
| |
Collapse
|
2
|
Alsarhani WK, Al-Sharif EM, Al-Faky YH, Alkatan HM, Maktabi AM, Alsuhaibani AH. Dacryops and clinical diagnostic challenges. CANADIAN JOURNAL OF OPHTHALMOLOGY 2022; 57:388-393. [PMID: 34324876 DOI: 10.1016/j.jcjo.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/23/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The study aims to describe the clinical and histopathologic features of different types of dacryops and their clinical diagnostic challenges. METHODS This is a retrospective cohort study of all surgically excised cases of dacryops in 2 tertiary eye hospitals in Riyadh, Saudi Arabia. RESULTS The study included 58 dacryops specimens from 55 patients with an average age of 41.2 years (range, 4-78 years). The most common location was the upper lid (60.3%), whereas the least expected location was the caruncle (6.9%). The most common site of dacryops occurrence was in the accessory lacrimal gland (55.2%), the main lacrimal gland (32.8%), and then ectopic dacryops (12%). All patients presented with lid swelling alone except for 3 patients who experienced secondary mechanical ptosis. On physical examination, conjunctival scarring existed in 4 patients (6.9%). Preoperative diagnosis of dacryops was accurate in 44.8% of the cases. Dacryops of the main lacrimal gland was accurately diagnosed clinically in all cases compared with other locations, which was statistically significant (p < 0.001). The causes of inaccurate clinical diagnoses were hidrocystoma (26.9%), inclusion cyst (11.5%), and dermoid cyst (7.7%), whereas the remaining cases were diagnosed as cysts without a specific subtype (53.9%). Recurrence of the lesion was observed in 2 cases (3.5%). No clinical or histopathologic factors were associated with a risk of recurrence. CONCLUSION Dacryops can represent a diagnostic challenge to ophthalmologists. Familiarity with clinical presentations and findings is required to diagnose dacryops outside the main lacrimal gland.
Collapse
Affiliation(s)
- Waleed K Alsarhani
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Department of Ophthalmology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
| | - Eman M Al-Sharif
- Oculoplastics and Orbit Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; Department of Ophthalmology, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Yasser H Al-Faky
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, Riyadh, Saudi Arabia
| | - Hind M Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, Riyadh, Saudi Arabia; Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Azza M Maktabi
- Department of Pathology and Laboratory Medicine, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Adel H Alsuhaibani
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
3
|
Tanaboonyawat S, Idowu OO, Copperman TS, Vagefi MR, Kersten RC. Dacryops - A review. Orbit 2020; 39:128-134. [PMID: 31512543 DOI: 10.1080/01676830.2019.1608564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/13/2019] [Indexed: 06/10/2023]
Abstract
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.
Collapse
Affiliation(s)
- Sombat Tanaboonyawat
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Ophthalmology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Oluwatobi O Idowu
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Thomas S Copperman
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco, California, USA
| |
Collapse
|
4
|
Alsulaiman HM, Fatani DR, Al Sheikh O, Elkhamary S, Maktabi A, Alkatan HM, Schellini SA. Krause's accessory lacrimal gland dacryops - case report and literature review. Orbit 2020; 39:441-445. [PMID: 31914837 DOI: 10.1080/01676830.2019.1704796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The authors are describing two rare cases of dacryops involving the Krause accessory lacrimal glands and affecting the orbit. In both cases, the lesion was located in the inferior fornix, with no preceding trauma, surgery or trachomatous conjunctival scarring. The first case involved a clear orbital extension with evidence of optic nerve compression. The second case extended from the anterior orbit to the limbus. Both had surgical removal with good outcome. As Krause gland dacryops are similar to other orbital cysts, clinical, imaging and histopathologic evaluation are essential to confirm the final diagnosis.
Collapse
Affiliation(s)
- Hamad M Alsulaiman
- Oculoplastics, King Khaled Eye Specialist Hospital , Riyadh, Saudi Arabia
| | - Dalal R Fatani
- Oculoplastics, King Saud University , Riyadh, Saudi Arabia
| | - Osama Al Sheikh
- Oculoplastics, King Khaled Eye Specialist Hospital , Riyadh, Saudi Arabia
| | - Sahar Elkhamary
- Oculoplastics, King Khaled Eye Specialist Hospital , Riyadh, Saudi Arabia.,Radiology department, Mansoura Faculty Of Medicine , Mansoura, Egypt
| | - Azza Maktabi
- Oculoplastics, King Khaled Eye Specialist Hospital , Riyadh, Saudi Arabia
| | - Hind M Alkatan
- Oculoplastics, King Saud University , Riyadh, Saudi Arabia
| | | |
Collapse
|
5
|
Galindo-Ferreiro A, Alkatan HM, Muinos-Diaz Y, Akaishi PM, Galvez-Ruiz A, Cruz AV. Accessory lacrimal gland duct cyst: 23 years of experience in the Saudi population. Ann Saudi Med 2015; 35:394-9. [PMID: 26506974 PMCID: PMC6074379 DOI: 10.5144/0256-4947.2015.394] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Hind Manaa Alkatan
- Dr. Hind Manaa Alkatan, Ophthalmology Department,, College of Medicine,, King Saud University,, PO Box 18097, Riyadh 11415,, Saudi Arabia, T: +966112052054, F: +966112052740, ,
| | | | | | | | | |
Collapse
|
6
|
Shin SA, Choi CW, Kim SD. Clinical Evaluation of Lacrimal Gland Ductal Disease. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seon Ae Shin
- Department of Ophthalmology, Wonkwang University School of Medicine, Institute of Wonkwang Medical Science, Iksan Korea
| | - Chang Wook Choi
- Department of Ophthalmology, Wonkwang University School of Medicine, Institute of Wonkwang Medical Science, Iksan Korea
| | - Sang Duck Kim
- Department of Ophthalmology, Wonkwang University School of Medicine, Institute of Wonkwang Medical Science, Iksan Korea
| |
Collapse
|
7
|
Kacerovska D, Michal M, Ricarova R, Frdlikova D, Sosna B, Kazakov DV. Apocrine secretion in lacrimal gland cysts (dacryops): a common but underrecognized phenomenon. J Cutan Pathol 2011; 38:720-3. [PMID: 21752047 DOI: 10.1111/j.1600-0560.2011.01736.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
Collapse
Affiliation(s)
- Denisa Kacerovska
- Sikl's Department of Pathology, Charles University, Medical Faculty Hospital, Pilsen, Czech Republic
| | | | | | | | | | | |
Collapse
|