Oman Journal of Ophthalmology

CLINICAL QUIZ
Year
: 2015  |  Volume : 8  |  Issue : 3  |  Page : 215-

Nonprogressive, bilateral painless swellings of the lacrimal glands


Upender Wali, M Kashinatha Shenoy, Buthaina Al-Sabt, Abdullah Al-Mujaini 
 Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Oman

Correspondence Address:
Dr. Abdullah Al-Mujaini
Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat
Oman




How to cite this article:
Wali U, Shenoy M K, Al-Sabt B, Al-Mujaini A. Nonprogressive, bilateral painless swellings of the lacrimal glands.Oman J Ophthalmol 2015;8:215-215


How to cite this URL:
Wali U, Shenoy M K, Al-Sabt B, Al-Mujaini A. Nonprogressive, bilateral painless swellings of the lacrimal glands. Oman J Ophthalmol [serial online] 2015 [cited 2022 Oct 4 ];8:215-215
Available from: https://www.ojoonline.org/text.asp?2015/8/3/215/169903


Full Text

A 22-year-old male presented with fullness in the lateral aspect of the right upper lid and swelling in right lateral canthal area since 6 years. The swelling has progressed minimally since then. He did not seek any medical treatment partly because the swelling was not grossly visible from outside, and partly he did not have any pain. There was no history of trauma. On examination an 8 mm × 4 mm translucent bluish-purple nodular soft cystic swelling with a hyperemic swollen conjunctival base was found in the palpebral portion of the lacrimal gland [Figure 1]. He had two transparent cysts in the palpebral portion of the lacrimal gland in the left eye as well. These were nontender with no associated involvement of adjacent structures or signs of inflammation. There was no preauricular or submandibular lymphadenopathy. Slit lamp examination both eyes showed normal anterior (cornea, anterior chamber, lens) and posterior segments.{Figure 1}

 Questions



What is the likely diagnosis? Describe three features in support of your diagnosis.What are the common differential diagnoses of nontender, cystic slow-progressing swelling of the lacrimal gland.

 View Answer

 Answers



Diagnosis: Right eye: Orbital dacryops; three distinguishing features:A nodular cystic lesion, originating from the palpebral portion of the lacrimal glandPainless, slowly enlarging massRare.Differential diagnoses:Primary or infiltrative tumors of the lacrimal glandCystic orbital dermoids or epidermoidsProlapsed lacrimal gland.

 Description



Cysts involving lacrimal gland are uncommon, and dacryops is a rare ophthalmologic finding.[1] Dacryops is a ductal cyst of the lacrimal gland, usually well-encapsulated. It can cause diplopia due to globe displacement or motility restriction.[2] Cysts of the palpebral lobe of the lacrimal gland are most common and usually occur unilaterally. Dacryops, however, is a rare cyst of the orbit and is often bilateral. It originates from the palpebral or orbital portion of the lacrimal gland and usually produces fullness in the superior fornix. Dacryops is thought to be due to prolapse of the lacrimal gland to a sufficient degree to produce obstruction of the lacrimal ducts and chronic inflammation of the lacrimal gland tissue that weakens the wall of the ductules and allows them to expand. Trauma has been implicated in the etiology of dacryops.[3] These cysts are diagnosed easily on clinical examination with a classical appearance of a nontender, lateral upper lid swelling along with circumscribed, bluish, translucent cysts in the cul-de-sac of the superior temporal orbit (as in our case). Cases having tenderness and irritation have been reported.[4] Recent evidence suggests dacryops can be a sequel of scarring or obstruction of the lacrimal ducts following repeated orbital surgeries including keratoprosthesis.[5] Dacryops can be distinguished from cystic orbital dermoids and epidermoids. The later two are typically associated with a well-corticated, bony fossa in the adjacent orbit because they arise within the bony diploe. Fat or keratineceous densities within the cystic cavity are characteristic of dermoids and epidermoids. Dacryops infections can be characterized through imaging with or without histopathology in the differential of ocular adnexal masses in the setting of infection.[6] Histopathologically dacryops has a cystic space lined by columnar epithelial cells consistent with ductal origin. Though orbital dacryops is a distinct clinical entity, sonographic and computed tomography/magnetic resonance imaging scans may be indicated mainly to distinguish from other lacrimal gland tumors. Treatment options include excision through lateral orbitotomy or marsupialization.[7] However, our patient refused to undergo surgery.

References

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5Gonzalez-Saldivar G, Lee NG, Chodosh J, Freitag SK, Stacy RC. Dacryops in the setting of a Boston type II keratoprosthesis. Ophthal Plast Reconstr Surg 2014;30:e73-5.
6Kurup SP, Lissner GS. Characterization of dacryops infections. Ophthal Plast Reconstr Surg 2015;31:58-62.
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