Introduction:
Dacryops is otherwise known as lacrimal gland cysts or lacrimal duct cysts. This eye disease was described 200 years ago. Dacryops is a rare benign condition characterized by a fluid-filled cyst. It is usually asymptomatic; sometimes, it presents with varied signs and symptoms depending on the type and associated complications. Previously, it was thought that dacryops develop due to obstruction or subsequent build-up of secretions. However, at present, the cause is thought to be multifactorial, arising from chronic inflammation, an immune response, and IgA secretion. Surgery is found to be the mainstay of treatment for symptomatic cases.
What Is a Lacrimal System?
The lacrimal system involves the structures that help produce and drain tears. This lacrimal gland is located on the lateral upper eyelid margin. The lacrimal gland produces about 10 mL of secretions every day. The lacrimal duct, which is situated within the bone, connects the lacrimal sac with the inferior meatus of the nose.
What Are Dacryops?
Dacryops is a rare phenomenon where a retention cyst develops within the lacrimal gland due to obstruction of the duct. It is also called a lacrimal gland cyst or lacrimal duct cyst. It can occur anywhere in the eye where lacrimal gland tissue is involved. The cysts develop insidiously and present as painless masses on the eyelids. It can cause diplopia due to globe displacement or motility restriction. This dacryops is often unilateral but can also occur bilaterally.
What Are the Epidemiology and Pathophysiology of Dacryops?
1. Epidemiology:
Dacryops is an uncommon condition and is considered rare. It can affect individuals of any age but is more commonly seen in adults. There is not a definitive prevalence rate due to its rarity.
2. Pathophysiology:
The drops of tears that the lacrimal sac produces are what maintain the eyes wet. Dacryops occur when there’s an obstruction or blockage in the ducts of the lacrimal gland, leading to the accumulation of secretions and the formation of a cyst. The cyst is typically filled with clear fluid and is usually painless unless it grows large enough to cause pressure on surrounding structures, leading to discomfort or visual disturbances. The exact cause of Dacryops is not always clear, but it can be associated with chronic inflammation, trauma to the eye, or sometimes even without an identifiable cause.
What Is the Difference Between a Cyst on the Lacrimal Caruncle and a Tear Duct Cyst?
Cysts in the lacrimal caruncle, found at the inner corner of the eye where the eyelids meet, differ from tear duct cysts in their location and impact. Lacrimal caruncle cysts appear as small, fluid-filled sacs near the caruncle, causing irritation or redness without affecting vision. Conversely, tear duct cysts involve the tear drainage system, leading to visible swelling near the inner eye corner. These cysts might trigger excessive tearing, redness, and, in severe cases, painful infections.
What Are the Causes of Dacryops?
Dacryops is considered to be caused by prolapse of the lacrimal gland to a certain extent to produce obstruction of the lacrimal ducts. It also causes chronic inflammation of the lacrimal gland tissue, weakening the walls of the ductules and allowing them to expand. Trauma is considered to be the major cause of dacryops.
How Does Dacryops Develop?
The major lacrimal glandular tissue is located in the anterior superolateral region of the orbit, which is responsible for tear production and secretion. Any obstruction in the lacrimal gland ductules can lead to the formation of dacryops, and ductal cysts of the lacrimal gland.
Dacryops is a very rare phenomenon, usually presenting unilaterally in the palpebral lobe. A history of trauma or a congenital anomaly of the excretory duct can be one of the precipitating factors for the development of cysts.
The pathogenesis behind the formation of cysts is related to periductal or conjunctival inflammation or trauma resulting in lacrimal gland hypersecretion, damage to ductule walls, and secondary ductule obstruction. These damaged walls then passively dilate and result in cyst formation. The cysts usually grow very slowly, but rapid growth can occur, particularly when a superimposed infection occurs. These cyst growths can eventually cause symptoms like proptosis.
How Does Dacryops Manifest?
Dacryops presents the following signs and symptoms, such as:
-
Cysts appear smooth-walled, with bluish-gray areas in the superolateral region of the orbit.
-
It is a slowly enlarging mass.
-
The most common sign is the visible protruding mass while everting the upper eyelid. They are typically unilateral but can also be bilateral if they are caused by illnesses such as Sjogren’s syndrome, Mikulicz syndrome, sarcoidosis, or lymphoproliferative disorders. Some patients also report tenderness and irritation.
How Is Dacryops Classified?
Dacryops can be classified depending on the location of the cyst, which includes:
-
Palpebral Lobe Cysts - These cysts are found between the medial and lateral canthi.
-
Orbital Lobe Cysts - it is found in the orbit of the eye.
-
Tumors in Krause and Wolfring auxiliary lacrimal ducts.
-
Cysts of ectopic lacrimal glands.
How Is Dacryops Diagnosed?
Generally, dacryops are directly visualized on clinical examination, typically revealing a rubbery, mobile nodule. The size may vary, and the tenderness can be absent. These lesions will also transilluminate. These cysts have a bluish hue. The Seidel test can be positive near the cyst.
Other Diagnostic Examinations Include:
Histological Examination:
On histological examination, these lesions are characterized by a fluid-filled cyst that can be collapsed and surrounded by an epithelial layer. A definitive and prompt diagnosis can be made after a histopathological examination where the cyst has one to two layers of epithelium and a clear lumen.
Computed Tomography (CT):
This diagnostic test is recommended to examine the fluid density of cyst, palpebral, and orbital types. There is no thick or nodular enhancement or associated bony erosion or destruction.
Magnetic Resonance Imaging (MRI):
This diagnostic test determines a fluid-intensity cyst with no post-contrast enhancement.
A large mass around the lacrimal gland is usually visible on CT and MRI scans.
What Are the Differential Diagnosis of Dacryops?
The Differential Diagnosis of Dacryops Include:
-
Orbital dermoid cysts.
-
Post-traumatic hemorrhagic cyst.
-
Conjunctival cyst.
-
Adenoid cystic carcinoma.
-
Abscess.
Can Dacryops Be Treated?
The treatment for symptomatic dacryops usually involves a local resection through a superotemporal conjunctival forniceal approach. Care must be given to avoid the destruction of the remaining tear ducts that drain the palpebral lobe. Some dacryops resolve with topical antibiotics or steroid ointment. Surgical cyst excision can be curative, and observation is also a mandatory and safe method in selected cases.
Excision with or without marsupialization is known to prevent the recurrence and drainage of the cyst. In addition, antibiotic therapy can successfully manage the infection and cyst size. In a survey, it was found that there was no recurrence of cysts in patients who underwent surgery, and the symptoms did not deteriorate in patients on observation.
What Are the Complications of Dacryops?
The Complications of Dacryops Include:
-
Infection.
-
Hemorrhage into the cyst.
-
Rupture.
Conclusion:
Dacryops is a rare condition, but it can be easily identified with or without imaging methods. Surgical excision of the cyst can be curative, and there were no chances of recurrence in patients who underwent surgery.
