Hamad M. Alsulaiman , Dalal R. Fatani , Osama Al Sheikh , Sahar Elkhamary , Azza Maktabi , Hind M. Alkatan & Silvana Artioli Schellini
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.
Sombat Tanaboonyawat, Oluwatobi O. Idowu, Thomas S. Copperman, M. Reza Vagefi & Robert C. Kersten
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.
Anuradha Pradhan, Devjyoti Tripathy Dr., Ruchi Mittal
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.
Feijó, Eduardo Damous; Alencastro Landim, George; de Melo Dias, Mirna; Alves de Souza, Bruna Angelina; Murillo Limongi, Roberto; Matayoshi, Suzana
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.
Men, Clara J.; Yang, Patrick; Gur, Zvi; Paik, Ji-Sun; Kikkawa, Don O.; Korn, Bobby S.
A 69-year-old woman presented to the oculofacial plastic service with a painless superotemporal subconjunctival mass in the OS. Over the past year, the lesion had been progressively enlarging, resulting in horizontal diplopia with lateral gaze. Visual acuity was within normal limits with no evidence of optic neuropathy. On examination, the lesion was tense, transilluminated, and was clinically consistent with a simple dacryops. Complete excision of the lesion was planned under local anesthesia with monitored care. To facilitate complete removal of the lesion, fibrinogen and a mixture of thrombin and trypan blue were injected to fill the cyst cavity. This blue-stained fibrin clot allowed for easy visualization of the border and ensured complete excision without collateral damage to surrounding normal tissue. Simple dacryops is often difficult to remove completely with its capsule intact and this technique allows for clear delineation of the cyst and preservation of epithelial integrity for complete and efficient removal.
Cem Ozgonul, Yusuf Uysal, Onder Ayyildiz & Murat Kucukevcilioglu
Purpose: To describe clinical, imaging findings, and management of dacryops cases.
Methods: A retrospective chart review was performed to identify the patients diagnosed with dacryops over a 5-year period. The clinical features based on clinical findings, computerized tomography and ultrasonography, and observation and surgical excision results were noted when available.
Results: We included 14 eyes of 14 patients. Seven (50%) were men with a median age of 48 years. The most common symptom was non-painful upper eyelid mass. All patients had the visible protruding cyst while eversion of the upper eyelid. Imaging studies, including orbital computerized tomography and ultrasonography were performed in six cases. Histological assessment of the excised cyst was done in two cases. Surgical excision was performed in five (36%) cases and observation was elected for nine (64%) cases. The median follow-up was 30 months. There was no recurrence of cysts in patients underwent surgery and the symptoms were not deteriorated in patients elected observation.
Conclusion: Dacryops is a rare clinical entity that can be diagnosed easily with or without imaging methods. Surgical excision of the cyst could be curative and observation is also a safe method in selected cases.
Gautam Lokdarshi, Neelam Pushker, Seema Sen, Abdul Shameer, Mandeep S. Bajaj
Classically, dacryops have been described as an ectasia of lacrimal ductule(s) of uncertain etiology.1 In general, patients remain asymptomatic and cosmetic deformity of the lid is the usual reason for visiting an ophthalmologist.1 Being rare and simulating few other clinical conditions, many ophthalmologists are unfamiliar about this cyst and may advice unnecessary imaging.