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Year : 2022  |  Volume : 2  |  Issue : 4  |  Page : 997-998

Giant bulbar conjunctival retention cyst presenting with complete blepharoptosis


1 Fellow, Hima Bindu Yalamanchilli Centre for Eye Cancer, L. V. Prasad Eye Institute, Vijayawada, India
2 Faculty, Hima Bindu Yalamanchilli Centre for Eye Cancer, L. V. Prasad Eye institute, Vijayawada, India
3 Optometry Faculty, Hima Bindu Yalamanchilli Centre for Eye Cancer, L. V. Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
4 Ophthalmic Pathology Laboratory, L. V. Prasad Eye Institute, Hyderabad, Telangana, India

Date of Submission19-Jun-2021
Date of Acceptance26-Jul-2022
Date of Web Publication11-Oct-2022

Correspondence Address:
Dr. Anasua G Kapoor
Faculty, Ocular Oncology and Ophthalmic Plastic Surgery, Hima Bindu Yalamanchilli Centre for Eye Cancer, L. V. Prasad Eye Institute, Vijayawada
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1679_21

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  Abstract 


Keywords: Blepharoptosis, conjunctival cyst, eye, tumor


How to cite this article:
Gunda S, Madhuri KB, Mohammad M, Mishra DK, Kapoor AG. Giant bulbar conjunctival retention cyst presenting with complete blepharoptosis. Indian J Ophthalmol Case Rep 2022;2:997-8

How to cite this URL:
Gunda S, Madhuri KB, Mohammad M, Mishra DK, Kapoor AG. Giant bulbar conjunctival retention cyst presenting with complete blepharoptosis. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Nov 30];2:997-8. Available from: https://www.ijoreports.in/text.asp?2022/2/4/997/358203



A 62-year-old lady presented with a 2-year history of gradually progressive, right upper lid swelling. There was no history of ocular trauma or surgery. She had complete ptosis of the right upper lid [Figure 1]a. On eversion of the upper eyelid, subconjunctival cystic lesion was noted in superior quadrant [Figure 1]b and [Figure 1]c, posterior extent of which was not palpable. Fundus revealed right eye disc pallor due to old ischemic optic neuropathy. Magnetic resonance imaging (MRI) orbit showed right, large, well-defined upper eyelid cyst hypointense on T1 [Figure 1]d and hyperintense on T2 [Figure 1]e and [Figure 1]f, causing globe indentation and inferior dystopia. Excision biopsy of cyst in toto was performed. Intraoperatively, conjunctival cyst was noted to extend from the superior fornix to the limbus in the bulbar conjunctiva [Figure 2]a. The cyst measured 25 × 19 × 15 mm [Figure 2]b and was brilliantly tans-illuminated [[Figure 2]b, inset]. Histopathology showed cyst wall containing attenuated lining of cuboidal to flattened columnar epithelium and sub-epithelial, dense, chronic inflammation, suggestive of conjunctival inclusion cyst [Figure 2]c and [Figure 2]d. At 1.5 year follow-up, she had right aponeurotic ptosis [Figure 2]e with no cyst recurrence.
Figure 1: (a) Clinical photograph showing total blepharoptosis in the right eye. (b) Clinical photograph of both eyes in worm's-eye view showing cystic lesion under upper eyelid of the right eye. (c) On eversion of the upper eyelid, cystic lesion with surface vessels are seen. (d) MRI orbit T1 image axial section showing hypointense, well-defined, giant conjunctival cyst causing globe indentation. (e) and (f) MRI orbit T2 coronal and sagittal image showing hyperintense, giant, superior conjunctival cyst causing globe indentation

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Figure 2: (a) On table, conjunctival cyst was noted to extend from the superior fornix to the limbus in the bulbar conjunctiva. (b) Gross specimen of cyst photograph after its removal in toto (inset showing brilliant trans illumination of cyst). (c) Photomicrograph of cyst wall showing bilayer lining of epithelium (Hematoxylin and eosin [H&E], 1×) (blue arrow marks the epithelium and red arrow marks the sub epithelium). (d) Photomicrograph of cyst wall showing flattened, cuboidal epithelium and sub epithelial, dense, chronic inflammation (H&E, 20×) (blue arrow marks the epithelium and red arrow marks the sub epithelium). (e) Postoperative clinical photograph showing right eye blepharoptosis with no cyst recurrence

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  Discussion Top


Conjunctival inclusion cysts are benign in nature and can be primary (congenital) or secondary.[1] Secondary cysts result from implantation of the conjunctival epithelium into the substantial propria following inflammation, surgery, or trauma.[2] The majority of the conjunctival cysts are smaller in size with giant cysts being unusual. Although multiple treatment options like thermal cautery, intralesional alcohol or trichloroacetic acid injection, and laser ablation exists, the most common management option is cyst excision.[3] The most common complication following excision is recurrence due to incomplete removal. Lesions arising from bulbar conjunctiva, especially if large, result in ocular surface irritation and cosmetic deformities.[4] There are very few case reports of conjunctival cysts presenting with blepharoptosis.[5] In the present case, the cyst's being limited to the conjunctival space may cause mechanical effect with excessive stretching on the levator aponeurosis, leading to aponeurotic ptosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Operation Eyesight Universal Institute for Eye Cancer and Hyderabad Eye Research Foundation. The funders have no role in preparation of the manuscript.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Thatte S, Jain J, Kinger M, Palod S, Wadhva J, Vishnoi A. Clinical study of histologically proven conjunctival cysts. Saudi J Ophthalmol 2015;29:109-15.  Back to cited text no. 1
    
2.
Nath K, Gogi R, Zaidi N, Johri A. Cystic lesions of conjunctiva. Indian J Ophthalmol 1983;31:1.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Nejat F, Jadidi K, Pirhadi S, Adnani SY, Nabavi NS, Nejat MA. A novel approach to treatment of conjunctival cyst ablation using atmospheric low-temperature plasma. Clin Ophthalmol (Auckland, NZ) 2020;14:2525-32.  Back to cited text no. 3
    
4.
Ng DS, Ching RH, Yam JC, Chan CW. Safe excision of a large overhanging cystic bleb following autologous blood injection and compression suture. Korean J Ophthalmol 2013;27:145-8.  Back to cited text no. 4
    
5.
Sameshima SS, Beyer-Machule CK. Acquired ptosis associated with a conjunctival cyst. Ophthalmic Plastic Reconstr Surg 1988;4:159-62.  Back to cited text no. 5
    


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