Congenital Conjunctival Cysts of the Orbit

Abstract

Purpose: To evaluate the clinical presentation, anatomical location, and histological features of congenital conjunctival cysts of the orbit. The location and the histological features of inflammation in these patients were compared with those for 293 orbital dermoid cysts. Patients and Methods: Retrospective review of the clinical details, imaging, and histopathology for patients who had excision of conjunctival cysts from their orbit between 1992 and 2020; patients with a history of trauma or surgery were omitted. Results: Twelve patients (7 male; 58%) with congenital conjunctival cysts were identified, the patients presenting at an average age of 16 years (median 26; range 1–61) with a symptoms for a mean duration of 20 months (median 24; range 6–36). The commonest symptoms were peribulbar lump (6/12 patients; 50%), and eyelid swelling and blepharoptosis (6/12 patients; 50%). An orbitaxl mass was palpable in 10 patients (83%), 3 patients (25%) had mild proptosis (1–3 mm), and the cysts were most commonly located superiorly (6/12 patients; 50%) or superonasally (3/12; 25%) in the anterior half of the orbit. Imaging was performed in 7 cases, this showing an intimate relation to the common sheath of the superior rectus/levator complex in 3 patients (25%) and to the trochlea in 1 (8%). All cysts were excised completely, and no patient had postoperative complications or recurrence. Chronic mild and nonspecific inflammation was evident within the cyst wall in 7 cases (54%), but—unlike 55% of the 293 dermoid cysts—none showed granuloma formation. Conclusion: Congenital conjunctival cysts are rare and usually present with a palpable mass in the upper eyelid sulcus. A significant proportion of these cysts have an intimate relationship with the trochlea, or the superior rectus, levator palpebrae or superior oblique muscles and, to minimize the risk of postoperative diplopia or ptosis, particular care must be exercised during surgery.

Dumbbell-Shaped Congenital Conjunctival Cyst of the Orbit

“…2 A dumbbell-shaped cystic lesion in the orbital-temporal region is primarily suggestive of a dermoid cyst. As noted in a recent report, 5 a conjunctival cyst in this configuration has never been reported. To be precise, the term dumbbell should only be used for lesions connected by a narrow intraosseous canal whose both components are approximately equal in size and bulbous-shaped (i.e., "true dumbbell").…”

“…18,19 The present case represents a rare location and an atypical pattern for congenital conjunctival cysts. Other atypical cases related to the levator/superior rectus muscle complex, 5,15 arising from the inferior orbit, 6 or associated with an oncocytic differentiation, 11 have also been reported.…”

“…Congenital conjunctival cysts often appear in middle age and the upper medial or medial orbit. [2][3][4][5] They typically present with painless proptosis, globe displacement, palpable soft mass, and ptosis. Visual acuity and extraocular motility are usually unaffected.…”

“…Occasionally, thinning or bowing of the adjacent bone may occur, but a large osseous defect is very unusual. [3][4][5][6]8 Of the 54 cases in the literature we reviewed, only 1 had bone destruction. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] In this case, a recurrent cyst in the superolateral orbit was associated with frontal bone destruction.…”

“…[3][4][5][6]8 Of the 54 cases in the literature we reviewed, only 1 had bone destruction. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] In this case, a recurrent cyst in the superolateral orbit was associated with frontal bone destruction. 2 A dumbbell-shaped cystic lesion in the orbital-temporal region is primarily suggestive of a dermoid cyst.…”