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ARTICLE
Year : 1967  |  Volume : 15  |  Issue : 1  |  Page : 32-34

Implantation cyst of the conjunctiva following squint operation


Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India

Date of Web Publication18-Jan-2008

Correspondence Address:
G C Sood
Department of Ophthalmology, Maulana Azad Medical College, New Delhi
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Sood G C, Malik S, Gupta D K, Bhardwaj P C. Implantation cyst of the conjunctiva following squint operation. Indian J Ophthalmol 1967;15:32-4

How to cite this URL:
Sood G C, Malik S, Gupta D K, Bhardwaj P C. Implantation cyst of the conjunctiva following squint operation. Indian J Ophthalmol [serial online] 1967 [cited 2020 Dec 3];15:32-4. Available from: https://www.ijo.in/text.asp?1967/15/1/32/38677

Implantation cysts in general arise by traumatic implantation of skin, epithelium or hair bulbs into the un­derlying connective tissue. It is rather surprising that they are rare in con­junctiva in view of the fact that the conjunctiva is so much exposed to in­jury, intentional as well as uninten­tional.

The contents of an implantation cyst vary according to the type of epithe­lium which produces it. It may con­tain clear watery fluid, mucoid mate­rial, hair or sebacious material. The contents of the conjunctival cysts are clear and mucoid in character (Perkins 19.52).

An implantation cyst of conjunctiva is formed by submucous inclusion of epithelium which grows and degene­rates in the centre, leaving a cystic space containing clear fluid surrounded by laminated epithelium fixed to the sclera due to some degree of inflama­tion in the neighbourhood (Duke Elder, 1946). Duke Elder has collect­ed all the reported causes for such cyst-formations which may be grouped as follows:

(1) injuries to the conjunctiva with or without retention of a foreign body or cilium, with or without involvement of the underlying sclera,

(2) operations for strabismus. retinal detachment and expression of tracho­ma follicles,

(3) perforating limbal injury with iris prolapse

A case of implantation cyst of con­junctiva following squint operation is being reported.


  Case Report Top


N.F. 16 years, Muslim female was operated for a concomitant convergent squint by a 5 mm. recession of right medial rectus muscle in May 1964 at our department in the Irwin Hospital, Delhi. Early post operative period was uneventful and the patient was dis­charged on the fourth day. Two weeks later when she reported, the patient was noticed to develop a small swell­ing in the superomedial quadrant, in between the superior and medial recti, a little away from the limbus and ex­tending towards the fornix. There were no associated symptoms. The swelling gradually increased. The patient was readmitted on 4-6-64. On examination, the swelling was found to be about 1 cm x 1.5 cm, non tender, well cir­cumscribed, cystic and adherent to the underlying structures with complete absence of any signs of inflammation [Figure - 1].

Surgical removal of the encapsu­lated cyst en mass was attempted on 5-6-64 but the cyst burst discharging thick fluid. As much as possible of the cyst was removed and sent for his­topathological examination which re­vealed it to be a conjunctival implan­tation cyst [Figure - 2]. Three weeks after this removal, the patient again noticed a similar swelling at the same site. On 6-7-64 when the patient visited us for check up, we found a well circum­scribed swelling of about 1.5 cm in dia­meter adherent to the underlying struc­tures situated at the site of the previous swelling. There was no inflammation around it and movements of the eye ball were normal. The cyst was re­moved completely this time. On open­ing the cyst it was found to contain a thin mucoid fluid and a black silk su­ture. Biopsy report again showed it to be a conjunctival implantation cyst. This was followed by uneventful re­covery and no recurrence has been seen during the ten months of follow up.


  Discussion Top


Implantation cysts of conjunctiva are rare (Perkins 1952) and even fewer cases are reported after squint sur­gery. In view of the fact that the conjunctiva is exposed to much trau­ma, intentional or unintentional, it is surprising that one does not come across a conjunctiva implantation cyst more often. It is possible that there may be some protective mechanism against cyst formation on epithelium implantation.

The possibility of antibody forma­tion against the implanted epithelium is ruled out by the studies of Hilding (1960) who failed to demonstrate any such antibodies after experimental im­plantation of conjunctival, corneal and sinus epithelium into the anterior chamber of animals.

There is also the possibility of the presence of a non absorbable foreign body interfering with any natural pre­ventive mechanism that may exist, as in our case where a silk suture was found. Post operative reaction from such a foreign body may well be the cause of neutralization of such a pre­ventive mechanism.

It is therefore suggested that absorb­able suture material be used instead of non absorbable silk in squint surgery. This is likely to reduce the incidence of implantation cyst after squint sur­gery.


  Summary Top


A case of implantation cyst of con­junctiva following squint operation is described.

The different possible ways in which such a cyst may occur are discussed.

Use of absorbable material in squint surgery is advocated which is likely to reduce the incidence of implantation cyst.[14]

 
  References Top

1.
Ascott J. R., (1942), Brit. Jr. Ophth. 26, 126.  Back to cited text no. 1
    
2.
Collins (1896) as quoted in 3.  Back to cited text no. 2
    
3.
Duke Elder S., (1946), Textbook of Ophthalmology. Vol. 2, p. 1771. Henry Kimpton. London.  Back to cited text no. 3
    
4.
Hilding A. C.. (1960). Am. Jr. Ophth. 50, 276.  Back to cited text no. 4
    
5.
Lange K. M., (1903) as quoted in 3.   Back to cited text no. 5
    
6.
Mayou (1905) as quoted in 3.   Back to cited text no. 6
    
7.
Oatman (1907). as quoted in 3.   Back to cited text no. 7
    
8.
Passera, (1910). as quoted in 3.  Back to cited text no. 8
    
9.
Perkins E. W. (1952), Am. Jr. Ophth. 35/2. 196-98.  Back to cited text no. 9
    
10.
Poyales (1923). as quoted in 3.  Back to cited text no. 10
    
11.
Shoda (1924). K. M. Aug. lxxiii 223.   Back to cited text no. 11
    
12.
Uhthoff (1879). as quoted in 3.  Back to cited text no. 12
    
13.
Wolff E. (1928), Proc. Roy. Soc. Med. (Sect. Oph) 22, 4-6.  Back to cited text no. 13
    
14.
Xilo (1920). as quoted in 3.  Back to cited text no. 14
    


    Figures

  [Figure - 1], [Figure - 2]



 

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