Lacrimal Cyst – Causes, Symptoms, Complications, Prognosis, Treatment

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Lacrimal glands or tear glands are the glands located in our eyes. They serve the function of producing the tears. Lacrimal Cyst is a membranous sac containing fluid, formed in the lacrimal gland or duct. 

Other names of Lacrimal Cyst

• Dacryops
• Lacrimal gland cyst
• Lacrimal duct cyst
• Lacrimal gland duct cyst

Lacrimal Cyst

Lacrimal Cyst is an uncommon but benign condition characterized by a fluid filled cyst associated with normal lacrimal tissue. Lacrimal cyst commonly occurs in the lacrimal gland, but any lacrimal tissue can produce cysts. These tissues include accessory lacrimal glands and ectopic lacrimal tissue. This condition was described more than 200 years ago.

Ayurveda correlation

A similar condition resembling Lacrimal Cyst has been explained in the Netra Rogas (eye diseases) of Ayurveda, in the sandhigata netra rogas to be precise (diseases occurring at the junctions of eye parts, at the junction of the eye lids in this context). That is called as Kaphaja Upanaha.
Related Reading – Upanaha (Netra Roga) – Definition, Symptoms, Treatment

Causes

Trachoma – Trachoma is considered the most common etiology for lacrimal cyst (Trachoma is an infectious disease caused by bacterium Chlamydia trachomatis. It causes roughening of the inner surface of the eyelids.).

Ocular cicatricial pemphigoid – It is a chronic, bilateral, progressive scarring and shrinkage of the conjunctiva with opacity of cornea. Symptoms include hyperemia and irritation. Progression of the disease leads to eyelid and corneal damage and sometimes blindness.

Chemical Injury – to the eye
Idiopathic – Sometimes lacrimal cysts may be idiopathic (occurs spontaneously, causes unknown)

Symptoms

• Visible swelling – Patients may complain of visible swelling of the eyelid. These are said to enlarge slowly, the size also may vary over time.
• Pain around the swelling
• Irritation of the eye
• Tenderness of the swelling (generally mild)

Signs

• Blepharochalasis (conjunctival mass)
• Ptosis (drooping or falling of the upper eyelid)
• Proptosis (abnormal protrusion of eye)
• Hypoglobus (downward displacement of the eye in its orbit)

Note: The last 3 conditions can occur if the cyst is large in size

Pathophysiology

Studies have shown that lacrimal cyst are not caused due to occlusion of lacrimal system. Instead, in lacrimal cysts, atrophy of the occluded lacrimal system is seen. In these conditions, the pressure within the lacrimal apparatus is low. High levels of secretory IgA have been identified in the cystic fluid. Also, strong immunohstochemical staining of cyst wall epithelium was also found in lacrimal cyst. Hypersecretion of IgA into the lumen of the cyst with resultant osmotic retention of fluid and expansion of the cyst are proposed as important steps in pathogenesis of lacrimal cysts.

Other theory – Trauma or inflammatory conditions of lacrimal apparatus could cause damage to the lacrimal duct walls. This could predispose to dilation of these ducts forming cysts.

Diagnosis

Diagnosis is made on clinical finding of cystic swelling in the eye and also based on the history elicited from the patient.
Diagnostic aspiration of cyst, ultrasound tests and CT could be helpful in diagnosis but are generally not considered as mandatory.

Differential Diagnosis

• Dermoid cysts
• Frontal muoceles
• Implantation cysts
• Aneurismal bony cysts
• Lateral rectus muscle cysts
• Parasitic cysts
• Cysts of the lid adnexal structures
• Lacrimal neoplasms and vascular malformation

Examination

• The cyst can often be directly visualized within the fornix. It typically appears like a rubbery, mobile nodule.
• Size of the nodule may vary. Tenderness may be mild, sometimes absent also.
• Transillumination – these cysts will pass the transillumination test (passing of a strong beam of light through the cyst). The cysts may have a blue hue.
• Seidel test may be positive near the cyst (shows preserved, patent lacrimal ductules)

Treatment

Marsupialization (surgical technique of cutting a slit into the cyst and suturing the edges of the slit to form a continuous surface from the exterior surface to the interior surface of the cyst) should be preferred when lacrimal cyst is symptomatic.

Complications

Formation of fistulae in the cysts
Infection of cysts

Prognosis

Recurrence of the lesion after excision may occur due to incomplete removal.
Injury and scarring of the lacrimal gland and ductules
Click to Consult Dr Raghuram Y.S. MD (Ayu) – Email / Skype