Conjunctival Cysts as a Complication After Strabismus Surgery

Guadilla, A.M.; Liaño, P. Gómez de; Merino, P.; Franco, G.

doi:10.3928/01913913-20100818-02

Cited by 17 publications

(8 citation statements)

References 8 publications

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“…[3][4][5][6] This complication has a reported incidence of 0.25% after strabismus procedures. 7 The purple/blue grayish hue of such cysts, noted in our patient, has been previously cited along with the frequent delay in growth, secondary strabismus, and clinical presentation for evaluation. 6,8 Although thermal cauterization or intralesional injection with isopropyl alcohol have been successfully used to shrink some conjunctival cysts, 9,10 these techniques do not address the large secondary incommitant strabismus associated with many giant conjunctival cysts.…”

Section: Diagnosis and Discussionsupporting

confidence: 70%

A 50-year-old man with a long-standing, large-angle exotropia and limitation of adduction in the left eye

Mehendale¹,

Stemmer‐Rachamimov²,

Dagi³

2013

Digit J Ophthalmol

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HistoryA 50-year-old man was referred for management of a long-standing, large-angle exotropia and limitation of adduction in the left eye. He had a history of poor vision in the left eye since childhood and 4 previous strabismus procedures. The most recent strabismus surgery was 38 years before presentation. Prior records were unavailable, and the patient could not recall any details pertaining to his earlier procedures or alignment in childhood. His wife did not report any recent change in his appearance or alignment. ExaminationBest-corrected visual acuity was 20/15 in the right eye and 20/200 in the left eye. There was no afferent pupillary defect, and color vision was full and symmetric. The patient had an exotropia of 40 prism diopters (PD) at distance and 45 PD at near, with a −3 adduction deficit of the left eye greatly increasing the exotropia in right gaze to 60 PD. There was a 2 mm ptosis of the left upper eyelid.Anterior segment examination revealed conjunctival scarring over the medial and lateral fornices of both eyes. A palpable, painless, soft, purple-gray mass, 8 mm in horizontal diameter and of indeterminate depth was detected in the superonasal aspect of the orbit of the left eye. It extended subconjunctivally posterior to the caruncle and superonasally toward the upper lid. One large superficial conjunctival vessel penetrated the lesion (Figure 1). The bulk of the mass was apparent through closed lids. The patient was unaware of the presence of this mass. The remainder of the ophthalmological examination was unremarkable, including anterior chamber evaluation, intraocular pressure, fundus examination, and visual fields. Ancillary TestingDue to the heterogeneous color of the mass, the penetrating vessel, and the lack of adequate history, magnetic resonance imaging (MRI) of the orbits was performed to rule-out malignancy. The MRI showed a well-encapsulated cyst overlying the medial globe, with no evidence of erosion or invasion of surrounding structures. The medial rectus muscle appeared to insert at the posterior pole of the cyst (Figure 2).

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Section: Diagnosis and Discussionsupporting

confidence: 70%

A 50-year-old man with a long-standing, large-angle exotropia and limitation of adduction in the left eye

Mehendale¹,

Stemmer‐Rachamimov²,

Dagi³

2013

Digit J Ophthalmol

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“…It has been suggested that careful retraction of tissues may prevent this complication. They may disappear spontaneously, but persistent cases often require surgical excision [16]- [18]. In our case, conjunctival cyst occurred in the nasal sector four months after medial rectus recession for partially refractive accommodative esotropia.…”

Section: Discussionmentioning

confidence: 70%

Ocular Complications of Strabismus Surgery

Yurdakul¹,

Koç²

2014

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Background: To evaluate ocular complications of strabismus surgery at the Department of Strabismus and Neuroophthalmology in our clinic. Methods: The medical records of patients who underwent strabismus surgery between March 1999 and February 2013 were retrospectively reviewed. Patients with minor ocular complications such as wound irregularities, conjunctivitis, subconjunctival hemorrhage, and less than six-month follow-up periods were excluded from the study. Employed strabismus surgeries included recessions, resections, muscle advancements, inferior oblique myectomies, and muscle transpositions. Results: Our case series are comprised of 1468 patients who underwent strabismus surgery. The ages of the patients ranged from 6 to 80 years. Recognized primary ocular complications were noted in eight patients (0.5%). Scleral perforation with retinal break was observed in one myopic patient during retrobulbar anesthesia. Medial rectus rupture occurred during medial rectus recession in one patient with chronic complete sixth nerve palsy. Conjunctival cyst occured postoperatively in one patient with partially refractive accommodative esotropia who had bilateral medial rectus recession. Corneal dellen developed postoperatively in five patients with exotropia. Conclusion: Ocular complications of strabismus surgery are usually treatable. Damage to ocular structures can be prevented by meticulous surgical approach. Close postoperative follow-up is required in all cases.

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“…The incidence of epithelial inclusion cysts is reported to range from 0.25% to 0.4% of strabismus surgery. 1,7 The duration to development of the cysts can range from a few days to 70 years post-operatively. 8,9 Our patient shared a similar time-frame with a previous case report series of three patients by Anjali et al who reported the appearance of cyst at 2 -4 months.…”

Section: Discussionmentioning

confidence: 99%

“…10 Our case corresponded to reported literature where it was reported rectus recessions were associated with an increased incidence of cyst formation. 7 Treatment of Figure 5: Macroscopic appearance of excised cyst with cyst wall intact the cyst intraoperatively conjunctival epithelial inclusion cysts can be divided into non-surgical and surgical options. A trial of steroids is the first-line treatment as some cysts may resolve spontaneously.…”

Section: Discussionmentioning

confidence: 99%

Epithelial inclusion conjunctival cyst after strabismus surgery - a rare occurrence

Kee¹

2019

EyeSEA

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Background: Epithelial inclusion conjunctival cysts are a rare occurrence post strabismus surgery. These cysts if left untreated can enlarge and cause complications such as limitation of eye movements, strabismus, proptosis and compression of ocular structures. Here we present a case of epithelial inclusion cyst post routine medial rectus recession, which was successfully treated with surgical excision. Methods: Case Report Results: A 4-year old Malay girl with partially accommodative esotropia underwent uneventful bilateral medial rectus recession. Post-operatively 4 months later, she developed nasal conjunctival mass of her right eye. The conjunctival mass was unresponsive to topical steroids and surgical excision was performed. Histopathological examination confirmed the mass as epithelial inclusion cyst. Conclusion: Prompt diagnosis and management of epithelial inclusion cyst is crucial to prevent subsequent ocular complications. Conflicts of interest: The authors report no conflict of interest.

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Conjunctival Cysts as a Complication After Strabismus Surgery

Abstract: Recession may be a risk factor in the development of a conjunctival cyst caused by the high frequency of dragging Tenon capsule during this surgical technique.

Cited by 17 publications

References 8 publications

A 50-year-old man with a long-standing, large-angle exotropia and limitation of adduction in the left eye

A 50-year-old man with a long-standing, large-angle exotropia and limitation of adduction in the left eye

Ocular Complications of Strabismus Surgery

Epithelial inclusion conjunctival cyst after strabismus surgery - a rare occurrence

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