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ARTICLES
Year : 1977  |  Volume : 25  |  Issue : 3  |  Page : 40-41
 

An encysted lacrimal mucocele with orbital extension


Grant Medical College, Mumbai, India

Correspondence Address:
Gyanam Krishnamurthy
Sir C.J. Ophthalmic Hospital, Grant Medical College, Mumbai-8
India
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PMID: 614272

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How to cite this article:
Krishnamurthy G, Padmawar B U, Desai Y. An encysted lacrimal mucocele with orbital extension. Indian J Ophthalmol 1977;25:40-1

How to cite this URL:
Krishnamurthy G, Padmawar B U, Desai Y. An encysted lacrimal mucocele with orbital extension. Indian J Ophthalmol [serial online] 1977 [cited 2014 Sep 2];25:40-1. Available from: http://www.ijo.in/text.asp?1977/25/3/40/31269


Mucocele is the commonest swelling of the lacrimal Sac. It is uncommon to encoun­ter an enormous encysted mucocele though a few cases are in record[1],[2],[3],[4],[5]. The purpose of this communication is to report a case of an cncys­ted lacrimal mucocele, breaking through the orbital septum into the orbit, which is of rare occurrence and has not been reported so far in the literature.


   Case report Top


A 35 years female was admitted in Sir C. J. Ophthalmic Hospital, with the complaints of right epiphora for last 2½ years and a swelling over the right lacrimal sac region for 2 years. There was history of fluid being aspirated from the swelling 6 months back, resulting in temporary reduction in the size of the swelling. Patient noticed sudden increase in the size of the swelling 2 weeks back, associated with narrowing of the right eye. There was no history of repeated attacks of sinusitis, rhinitis or pharyngitis.

On examination, left eye was normal. Right eye showed a globular, 3 cms by 3 cms, non-tender, irreduci­ble swelling in the region of the lacrimal sac, below the medial palpebral ligament. The swelling had pushed the lower lid upwards, causing narrowing of the palpeh­rat aperture [Figure - 1]. Blood vessels over the swelling were engorged. The swelling was fluctuant and transil­luminant. Right eyeball was normal. Visual acuity of both eyes was 6/6. Syringing of right lacrimal passage revealed complete block at the level of common canali­culus, while left side passages were patent X-ray of right orbit showed soft tissue shadow in the region of the lacrimal sac and along the infero-medial wall of the orbit. and no bony erosion. Dacryocystography of the left lacrimal passage was normal. The dye could not be injected into the right right sac due to the block at the level of the common canaliculus. Ear, nose and throat check-up were normal. A clinical diagnosis of encysted mucocele was made.

The mucocele was dissected enmasse through a curvilinear skin incision of 2 cms, over its most promi­nent part, falling short superiorly, at the medial palpeb. ral ligament. All the boundaries of the mucocele were easily accessible except the inferior boundary, where through a break in the orbital septum it was extending into the floor of the orbit for a distance of 1 cm. About 5.5 c.c. of thick mucoid fluid was aspirated from the mucocele. The empty sac was isolated and excised enmasse. The rent in the orbital septum was repaired and the wound was closed in layers.

The mucoid fluid was sterile. Histopatholagy of the mucocele was consistent with chronic non-specific inflammation.


   Discussion Top


An encysted mucocele is the end result of the stagnation of the secretion of the sac, due to sealing of its exits. The size of such an encysted mucocele varies from a pea­nut to an almond. An enormous encysted mucocele extending from the lateral canthus to the angle of the mouth, overlapping the bridge of the nose,, have been reported[3],[4],[5]. This extension is along the inferior orbital margin laterally and on the cheek inferiorly[1]. Orbital extension through a rent in the orbital septum is rare and curious. The interesting feature in our case, is orbital extension of the mucocele for a distance of one cm. into the floor of the orbit. This is due to the anatomical fact, that the orbital septum is weak at the inferior and medial margin[6]. The pressure by an enormous, firm and tense mucocele has thus produced a rent in this weak area, with the resultant orbital extension. The predisposing factor was the sudden increase in the size of the mucocele within a short period, making it firm and tense.

Further, this orbital extension of an encys­ted mucocele has pushed the lower lid upwards, causing narrowing of palpebral aperture. Had this enormous, firm, tense, encysted mucocele extended further into the orbit, it would cause displacement of the eyeball and orbital tissues. Hence, the importance of early removal of such enormous encysted lacrimal mucoceles.


   Summary Top


An interesting case of encysted lacrimal mucocele with orbital extension, causing up­ward displacement of the lower lid and narrow­ing of the palpebral aperture, has been reported, because of its rare occurrence.

 
   References Top

1.Duke Elder, S: 1974, System of Ophthalmology, 43, 704, The Ocular adnexa, II, Henry Kimptom London.  Back to cited text no. 1    
2.Meyer, F.W :1947, Klin. Mbl. Augenheilk, 1.2, 82, (Cited) By Duke-Elder).  Back to cited text no. 2    
3.Rollet: 1904, Ann. Oculist (Paris), 132, 279, (Cited by Duke-Elder).  Back to cited text no. 3    
4.Rutten: 1902, Clin. Ophthal., 8, 231. (Cited by Duke-Elder).  Back to cited text no. 4    
5.Valiere-Vialeix; 1939; Traite el' Ophthalmologic, Paris, 4, 164. (Cited by Duke-Elder)  Back to cited text no. 5    
6.Eugene Wolff: 1968., Anatomy of the Eye and Orbit, 193, H.K. Lewis and Co. Ltd. London.  Back to cited text no. 6    


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