Tarsal-related cysts: Different diagnoses with similar presentations

Purpose

To study different tarsal cysts that share similar presentations and are commonly misdiagnosed clinically as a chalazion.

Methods

A retrospective review of medical charts of all consecutive patients who presented eyelid tarsal-related pathology that needed surgical excision between 2010 and 2016 to a tertiary hospital was done. The data collected included preoperative, intraoperative and postoperative observations. Complete ophthalmologic examination at presentation, surgical procedures needed, complications, histopathological findings, response to treatment and follow-ups were recorded.

Results

Out of 850 patients who had an eyelid tarsal-related pathology, ten patients were found to have an eyelid cystic lesion related to the tarsus. All patients presented with an eyelid mass with no sign of local inflammation. All lesions were fixed to the tarsus with freely mobile overlying skin. Five patients had a recurrent lesion that was misdiagnosed and surgically treated as a chalazion. All patients underwent a surgical removal of these cysts, and a histopathological examination was performed. An intratarsal keratinous cyst was found in six patients and epithelial inclusion cyst was in one patient. Two patients found to have cystic structure lined by double cuboidal epithelium with numerous goblet cells consistent with benign lacrimal duct cyst (Dacryops).

Conclusion

Cysts related to the tarsal plate could have similar presentations. Careful clinical evaluation and histopathological examination play an important role in giving the right diagnosis and in providing the appropriate management.

Cyst Masquerading as Inadvertent Bleb After a Scleral-Fixated Intraocular Lens in Marfan Syndrome: A Case Report

INTRODUCTION

To present a case of an epithelial inclusion cyst masquerading as an inadvertent bleb in a patient with Marfan syndrome.

CASE REPORT

A woman with Marfan syndrome presented with a subluxed crystalline lens in her right eye, which progressively subluxed over the following 2 years. A lensectomy was performed with placement of an anterior chamber intraocular lens (IOL); however, the patient experienced blurred vision and photopsias and preferred IOL explantation. The IOL was removed and a scleral-fixated posterior chamber IOL was placed. Vision improved with an uncomplicated postoperative course. Five months later, the patient experienced sudden onset redness and sharp pain in this eye. A 3-mm cystic lesion with tan material was found over a prior scleral incision site. Intraocular pressure was normal and no aqueous leaked from the lesion. Owing to concerns of an infected inadvertent bleb, treatment with topical and oral antibiotics was started, but the lesion did not change in appearance and the patient experienced persistent pain. The lesion was surgically excised and histopathology revealed a conjunctival epithelial inclusion cyst with intralesional keratin. A month later, another conjunctival inclusion cyst developed and was excised per patient preference.

CONCLUSION

Marfan syndrome is characterized by defects in the FBN1 gene and may theoretically lead to an abnormal sclera, increasing the risk of bleb formation after scleral incision. Distinguishing between a filtering bleb and an epithelial inclusion cyst is critical in patient care. Although retained keratin from a cyst may mimic a bleb with purulence, intraocular pressure, aqueous leakage, and response to topical antibiotics may help distinguish between the two.

Atypical manifestation of conjunctival epithelial inclusion cyst: a case report

PURPOSE

To report a case of primary conjunctival epithelial inclusion cyst with atypical manifestation.

METHODS

A 66-year-old woman presented with a yellowish, subconjunctival mass extending from the corneal limbus to the medial canthus in the left eye. Clinical, radiological and histological assays were performed.

RESULTS

The mass was well-delineated, and the overlying conjunctiva was normal. An enhanced axial orbit computed tomography scan showed a 7.7 × 3.6 mm, well-demarcated, convex-shaped enhanced mass. Neither a connection to the orbital area nor extrusion of intraconal fat was observed. Histological examination revealed that the lesion was a cystic mass that was lined by nonkeratinized, stratified squamous epithelium, and filled with mucous materials and cellular debris. The histologic diagnosis was consistent with conjunctival epithelial inclusion cyst.

CONCLUSION

A careful examination using clinical, radiologic and histological studies is essential for the differential diagnosis of subconjunctival mass.

Subconjunctival epithelial inclusion cyst complicating strabismus surgery: Early excision is better

Epithelial inclusion cysts can occur following otherwise-uncomplicated strabismus surgery. Because of their tendency to grow posteriorly into the orbit, they should be monitored closely or treated when relatively small. We report and discuss an illustrative case.