|Year : 1989 | Volume
| Issue : 4 | Page : 189-190
Cyst of ectopic (choristomatous) lacrimal gland
VA Rao, Varun Kwatra, Ashok Puri
Dept. of Ophthalmology, JIIPMER, Pondicherry - 605 006, India
V A Rao
Dept. of Ophthalmology, JIIPMER, Pondicherry - 605 006
Source of Support: None, Conflict of Interest: None
A rare case of cyst of an ectopic lacrimal gland in the bulbar conjunctiva is reported in a 40 year-old-man. The clinical presentation histopathology, differential diagnosis and treatment of this choristomatous lacrimal ductal cyst (Group IV according to Bullock's classification) is described.
|How to cite this article:|
Rao V A, Kwatra V, Puri A. Cyst of ectopic (choristomatous) lacrimal gland. Indian J Ophthalmol 1989;37:189-90
| Introduction|| |
The majority of lacrimal gland tissue is present in the orbital and palperbal lobes of the lacrimal gland and to a lesser extent, in the accessory glands of Krause and Wolfringz . In addition, ectopic lacrimal gland tissue may occur in the caruncle, bulbar conjuctiva, outer canthus, lower lid, intraocular and intraorbital regions . Cyst formation may occur in any location where lacrimal gland tissues are present although these are uncommonly reported in the ectopic lacrimal gland ,,.Here we present one such case in the bulbar conjuctiva with its differential diagnosis.
| Case report|| |
A 40 year-old-man presented with the complaint of a gradually increasing painless swelling in the bulbar conjunctiva near the outer canthus of ten days duration. There was no history of trauma or surgery. He was a strict vegetarian and never had pets like dogs and cats. On examination, there was slight fullness in the left outer canthal region. After retraction of the outer canthus, a bluish-white cystic swelling measuring 1.5 cms in diameter was found in the outer bulbar conjunctiva [Figure - 1]. It was nontender, mobile, fluctuant, irreducible and brilliantly transilluminant. The visual acuity was 6/6 in each eye.
| Investigations|| |
Complete haemogram and stool examinations were normal. Casoni's test was non-reactive.
Under infiltrative anaesthesia, the swelling was dissected free from its subconjunctival location and excised. Histopathological examination revealed a delicate thin walled cyst lined by flattened to cuboidal epithelium. Adjacent to this were lacrimal gland ducts lined by columnar cells [Figure - 2]. There was no recurrence during 6 months of follow-up.
| Discussion|| |
Cyst formation may occur wherever lacrimal gland tissue is present. Recently, Bullock et al  proposed the following classification of lacrimal ductular cysts : (1) palpebral lobe cysts (simple dacryops); (2) orbital lobe cysts; (3) cysts of the accessory lacrimal glands of Krause and Wolfring; and (4) cysts of ectopic (choristomatous) lacrimal glands. Ectopic lacrimal gland tissue may occur in any location in or around the eye . Cysts of ectopic lacrimal gland have been reported in the ciliary body and iris and one of such case has been mistaken for medulloepithelioma ,. Green and Zimmerman  reviewed 35 cases of lacrimal gland choristomas, eighteen of these were in the bulbar conjunctiva (10 involving the cornea); six, in the outer canthus; two in the lower lid; one, intraocular and eight, intraorbital.A cyst of the ectopic lacrimal gland may resemble an epidermoid or a dermoid cyst, conjunctival cyst or a parasitic cyst. However it is difficult to differentiate them clinically. The only way to diagnosis this is a histological examination after excision of the cyst.
A lacrimal ductular cyst is typically composed of two layers with lacrimal gland tissue as seen in the present case ,. An epidermoid cyst is lined by epidermis and is filled with laminated layers of horny material. A dermoid cyst is also lined by epidermis, but possesses adenexal structures. The contents of the cyst are a mixture of the various secretions of these adenexal structures. A conjunctival cyst is lined by non-keratinizing stratified squamous epithelium with variable numbers of goblet cells depending upon the location of the cyst. The origin of conjunctival cysts may be similar to that of dermoid and epidermoid cysts . The parasitic cyst would reveal the parasite as seen in Cysticercus cellulosae.
| References|| |
Bullock, J.D., Fleishman, J.A., et al. Ophthalmology. 93:.1355-60,1986.
Jones, L. T., Wobig, J. L., Surgery of the Eyelids and Lacrimal system. Edition 1. Birmingham, Aesculapius : 58, 1976.
Green, W. R., Zimmerman, L. E., Arch. Ophthalmol. 78: 318 - 27, 1967.
Hunter, W. S., Br. J. Ophthalmol. 44: 619 - 25, 1960.
Christensen, L., Anderson, E. D., Arch. Ophthalmol. 48: 19 - 29, 1952.
Reese, A., B., Tumour of the Eye. Harper and Row, 3rd ed.: 402 - 6, 1976.
Duke-Elder, S., System of Ophthalmology. Vol. 13, Part 2 : The ocular Adnexa Lacrimal Orbital and Para-orbital disease. London : Henry Kimpton, 638- 43, 1974.
Smith, S., Rootman, J. Surv. Ophthalmol. 30: 245 - 50, 1986.
Jakobiec, F. A., Bonanno, P. A., Sigelman, J. Arch. Ophthalmol. 96: 1404-9, 1978.
[Figure - 1], [Figure - 2]