|Year : 1967 | Volume
| Issue : 1 | Page : 32-34
Implantation cyst of the conjunctiva following squint operation
GC Sood, S.R.K Malik, DK Gupta, PC Bhardwaj
Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
|Date of Web Publication||18-Jan-2008|
G C Sood
Department of Ophthalmology, Maulana Azad Medical College, New Delhi
Source of Support: None, Conflict of Interest: None
|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
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|| |
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|| |
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|| |
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.
| References|| |
Ascott J. R., (1942), Brit. Jr. Ophth. 26, 126.
Collins (1896) as quoted in 3.
Duke Elder S., (1946), Textbook of Ophthalmology. Vol. 2, p. 1771. Henry Kimpton. London.
Hilding A. C.. (1960). Am. Jr. Ophth. 50, 276.
Lange K. M., (1903) as quoted in 3.
Mayou (1905) as quoted in 3.
Oatman (1907). as quoted in 3.
Passera, (1910). as quoted in 3.
Perkins E. W. (1952), Am. Jr. Ophth. 35/2. 196-98.
Poyales (1923). as quoted in 3.
Shoda (1924). K. M. Aug. lxxiii 223.
Uhthoff (1879). as quoted in 3.
Wolff E. (1928), Proc. Roy. Soc. Med. (Sect. Oph) 22, 4-6.
Xilo (1920). as quoted in 3.
[Figure - 1], [Figure - 2]