Congenital respiratory-type ciliated cyst of the lacrimal sac Bonafide cysts of the lacrimal sac are rare, with only a few reports in the literature. 1À3 Most are probably congenital in origin while others may be acquired. The epithelial lining of these cysts can be squamous or ciliated-respiratory in type, depending on the region of the sac lining that spawns the lesion. Conjunctival cysts arising from the medial regions of the forniceal conjunctiva must be distinguished from cysts deriving from the lacrimal sac. Other cyst-like conditions may be formed by closure of a dacryocystocele as a result of trauma or inflammation. 1,3 (A dacryocystocele is a diverticulum, a saccular outpouching of an epithelial-lined cavity, often resulting from an obstruction and attendant increased intraluminal pressure.) A lacrimal sac cyst presents as a Correspondence e30