|Year : 2021 | Volume
| Issue : 1 | Page : 78-80
Conjunctival inclusion cyst presenting as proptosis: A rare scenario
Indu B Narayanan, JK Ann, Dona Ann Mathew, Ani Sreedhar
Department of Oculoplasty, Little Flower Hospital, Ernakulam, Kerala, India
|Date of Submission||07-May-2020|
|Date of Acceptance||27-May-2020|
|Date of Web Publication||19-Apr-2021|
Dr. Indu B Narayanan
Department of Oculoplasty, Little Flower Hospital, Angamaly, Ernakulam, Kerala
Source of Support: None, Conflict of Interest: None
Conjunctival inclusion cysts are an uncommon complication following various surgeries. They usually present as cystic masses confined to the anterior segment. We report a case of large inclusion cyst with orbital extension, which presented as proptosis and diplopia.
Keywords: Conjunctival inclusion cyst, scleral buckling, strabismus
|How to cite this article:|
Narayanan IB, Ann J K, Mathew DA, Sreedhar A. Conjunctival inclusion cyst presenting as proptosis: A rare scenario. Kerala J Ophthalmol 2021;33:78-80
|How to cite this URL:|
Narayanan IB, Ann J K, Mathew DA, Sreedhar A. Conjunctival inclusion cyst presenting as proptosis: A rare scenario. Kerala J Ophthalmol [serial online] 2021 [cited 2021 Jun 13];33:78-80. Available from: http://www.kjophthal.com/text.asp?2021/33/1/78/314098
| Introduction|| |
Conjunctival inclusion cysts are benign lesions which are lined by stratified squamous nonkeratinizing epithelium, filled with serous fluid and shed cells. They can be either congenital or acquired. Acquired inclusion cysts occur due to implantation of conjunctival epithelium following trauma or surgery or may occur in inflammatory conditions. It has been reported following various surgeries – strabismus surgery, scleral buckling, pars plana vitrectomy, small incision cataract surgery,, glaucoma valve surgery, and subtenon anesthesia injection.
| Case Report|| |
A 54-year-old male presented with protrusion of the right eye, which was painless and gradually progressed over the past 4 years. He also had complaints of double vision. He had undergone scleral buckling surgery in the same eye 10 years back.
On examination, his best-corrected visual acuity was 6/9 (right) and 6/6 (left). The right eye showed gross eccentric proptosis of 30 mm with inferior dystopia [Figure 1]. A cystic swelling (8 mm × 6 mm) was noted beneath the superolateral conjunctiva, which was extending into the superior orbit. All extraocular movements were restricted [Figure 2]; elevation was maximally affected. Fundus examination in the right eye showed the attached retina with buckle effect. Left eye anterior segment examination was within normal limits, and the retina showed prophylactic laser marks.
Computed tomography of the orbit disclosed a cystic, nonenhancing, well-defined mass in the superior orbit with posterior extension, in relation to the buckle [[Figure 3] – axial cut with an arrow pointing the buckle], displacing the eyeball inferolaterally [[Figure 4] – coronal section]. There was no bony erosion.
Orbitotomy was done. A well-defined cystic mass was identified. Clear fluid was drained, and wall biopsy was sent for histopathology examination. It was reported as conjunctival inclusion cyst [Figure 5].
|Figure 5: Histopathology - stratified squamous epithelium lined cyst wall|
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One-month follow-up revealed orthophoric alignment of the eyes [Figure 6], with no extraocular movement restriction [Figure 7]. He had been followed up for 6 months, and there is no recurrence.
| Discussion|| |
Conjunctival inclusion cyst can be primary or secondary. Primary may be congenital which occurs due to excessive conjunctival invagination during the embryonic period. Acquired primary cysts occur due to chronic inflammation, wherein the loose epithelium gets implanted into the deeper tissue even with trivial trauma. Secondary cysts develop following trauma or surgery. Conjunctival inclusion cysts occur as an uncommon complication of common surgeries. It is most commonly seen following strabismus surgery and can present even decades after the procedure. Kalantzis et al. in a retrospective study described orbital implantation cysts, in which maximum cases were following strabismus surgery, orbital fracture repairs, evisceration/enucleation, and retinal detachment surgery in order.
Majority of the cysts are small, are anterior in location, and are often asymptomatic. But rarely, they can be large with orbital extension producing proptosis, extraocular movement restriction, and compromised cosmesis. One such case following scleral buckling was reported, wherein the patient presented 17 years after the surgery. Garg et al. reported conjunctival inclusion cyst which developed 1 year after scleral buckling, but it was confined to the anterior bulbar conjunctiva. Our patient presented to us after 10 years of surgery, but had complaints 6 years after the procedure. Similar clinical presentation had been reported as a complication of hydrogel explants which expanded their own, clinically misdiagnosed as conjunctival cyst. Treatment includes simple surgical excision, or with modifications such as injecting trypan blue and methylcellulose, intralesional injection of trichloroacetic acid, aspiration, and sclerotherapy.
Our case report enlightens the occurrence of inclusion cyst as an uncommon complication of many ocular surgeries and that it can have varied presentations.
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
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]