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Clinical Quiz

Nonprogressive, bilateral painless swellings of the

lacrimal glands
Upender Wali, M. Kashinatha Shenoy, Buthaina AlSabt, Abdullah AlMujaini
Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Oman

A 22yearold male presented with fullness in the lateral aspect of

the right upper lid and swelling in right lateral canthal area since
6years. The swelling has progressed minimally since then. He
did not seek any medical treatment partly because the swelling
was not grossly visible from outside, and partly he did not have
any pain. There was no history of trauma. On examination an
8mm4mm translucent bluishpurple nodular soft cystic
swelling with a hyperemic swollen conjunctival base was found in
the palpebral portion of the lacrimal gland[Figure1]. He had two
transparent cysts in the palpebral portion of the lacrimal gland
in the left eye as well. These were nontender with no associated

involvement of adjacent structures or signs of inflammation.

There was no preauricular or submandibular lymphadenopathy.
Slit lamp examination both eyes showed normal anterior(cornea,
anterior chamber, lens) and posterior segments.

Questions
1. What is the likely diagnosis? Describe three features in support
of your diagnosis.
2. 
What are the common differential diagnoses of nontender,
cystic slowprogressing swelling of the lacrimal gland.

Figure 1: Orbital dacryops right lacrimal gland

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DOI:
10.4103/0974-620X.169903

For answers please see page 220.

Copyright: 2015 Wali U, et al. This is an openaccess article distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Correspondence:
Dr. Abdullah Al-Mujaini, Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Oman. E-mail: mujainisqu@hotmail.com

Oman Journal of Ophthalmology, Vol. 8, No. 3, 2015

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Clinical Quiz

Answers for Clinical Quiz

Answers
1. Diagnosis: Right eye: Orbital dacryops; three distinguishing
features:

1. A nodular cystic lesion, originating from the palpebral
portion of the lacrimal gland

2. Painless, slowly enlarging mass

3. Rare.
2. Differential diagnoses:

1. Primary or infiltrative tumors of the lacrimal gland

2. Cystic orbital dermoids or epidermoids

3. Prolapsed lacrimal gland.

Description
Cysts involving lacrimal gland are uncommon, and dacryops is
a rare ophthalmologic finding.[1] Dacryops is a ductal cyst of the
lacrimal gland, usually wellencapsulated. It can cause diplopia
due to globe displacement or motility restriction.[2] Cysts of
the palpebral lobe of the lacrimal gland are most common and
usually occur unilaterally. Dacryops, however, is a rare cyst of
the orbit and is often bilateral. It originates from the palpebral
or orbital portion of the lacrimal gland and usually produces
fullness in the superior fornix. Dacryops is thought to be due to
prolapse of the lacrimal gland to a sufficient degree to produce
obstruction of the lacrimal ducts and chronic inflammation of
the lacrimal gland tissue that weakens the wall of the ductules
and allows them to expand. Trauma has been implicated in the
etiology of dacryops.[3] These cysts are diagnosed easily on clinical
examination with a classical appearance of a nontender, lateral
upper lid swelling along with circumscribed, bluish, translucent
cysts in the culdesac of the superior temporal orbit(as in
our case). Cases having tenderness and irritation have been

220

reported.[4] Recent evidence suggests dacryops can be a sequel of

scarring or obstruction of the lacrimal ducts following repeated
orbital surgeries including keratoprosthesis.[5] Dacryops can be
distinguished from cystic orbital dermoids and epidermoids.
The later two are typically associated with a wellcorticated,
bony fossa in the adjacent orbit because they arise within the
bony diploe. Fat or keratineceous densities within the cystic
cavity are characteristic of dermoids and epidermoids. Dacryops
infections can be characterized through imaging with or without
histopathology in the differential of ocular adnexal masses in
the setting of infection.[6] Histopathologically dacryops has a
cystic space lined by columnar epithelial cells consistent with
ductal origin. Though orbital dacryops is a distinct clinical entity,
sonographic and computed tomography/magnetic resonance
imaging scans may be indicated mainly to distinguish from
other lacrimal gland tumors. Treatment options include excision
through lateral orbitotomy or marsupialization.[7] However, our
patient refused to undergo surgery.

References
1.

BrownsteinS, BelinMW, KrohelGB, SmithRS, CondonG, CodereF.

Orbital dacryops. Ophthalmology 1984;91:14248.
2. DumanR, DumanR, BalciM. Diplopia due to Dacryops. Case Rep
Ophthalmol Med 2013;2013:549487.
3. TsaiFF, MukhopadhyayC, ZengJ, ShinderR. Bilateral marked dacryops
following trauma. Orbit 2012;31:4357.
4. SmithS, RootmanJ. Lacrimal ductal cysts. Presentation and management.
Surv Ophthalmol 1986;30:24550.
5. GonzalezSaldivarG, LeeNG, ChodoshJ, FreitagSK, StacyRC.
Dacryops in the setting of a Boston typeII keratoprosthesis. Ophthal Plast
Reconstr Surg 2014;30:e735.
6. KurupSP, LissnerGS. Characterization of dacryops infections. Ophthal
Plast Reconstr Surg 2015;31:5862.
7. SalamA, BarrettAW, MalhotraR, OlverJ. Marsupialization for lacrimal
ductular cysts(dacryops): A case series. Ophthal Plast Reconstr Surg
2012;28:5762.

Oman Journal of Ophthalmology, Vol. 8, No. 3, 2015