Corneoscleral Epithelial Cysts

Abstract

The presence of ectopic lacrimal tissue suggests a developmental etiology for such cysts. Marsupialization of the scleral portion of the cyst and chemical ablation of the lining epithelium of the corneal cyst with 20% trichloroacetic acid appears to be a safe and effective technique in the surgical management of corneoscleral epithelial cysts.

Congenital intrascleral cyst

“…These congenital lesions are considered to be developmental defects that usually enlarge at the first year of life, as was the case in our patient. Generally, they are located at the limbus at birth as a nidus, but expansion of the cyst into the cornea may develop later in childhood 2,3. Vision is often affected due to the distortion and scarring caused by the lesion on and around the limbus.…”

“…The presence of goblet cells is said to favor congenital origin 3. Rao et al2 reported the presence of glandular structures simulating lacrimal gland tissue and stated that this indicates the developmental nature of the lesion.…”

Management of an intrastromal corneal epithelial cyst, from simple drainage to keratoplasty

“…Trauma and developmental causes have been proposed in the pathogenesis of corneal cysts, of which the former seems more plausible. [1–3] In approximately 50% of the reported cases a specific traumatic event was present by which epithelial cells were introduced into corneal stroma. [4] Even in cases without noticeable history of corneal trauma, an undetected minor injury in the past can be considered.…”

“…Several surgical intervention have been suggested, including simple cyst aspiration and drainage, cyst wall excision, treating of cyst cavity by distilled water or balanced salt solution, chemical and electrical cautery, cryotherapy, and lamellar or penetrating keratoplasty. [1–8] Also, chemical solutions have been suggested for the destruction of epithelial cells including 10% acetic acid, 1% iodine, cocaine, 20% trichloroacetic acid, and 96% ethanol. [9] Herein, we present a case of a large intrastromal corneal epithelial cyst that has been successfully treated after multiple surgical interventions.…”

“…Probably due to greater turnover of surface epithelium in children than adults, majority of reported cases had occurred in children. [1–3] In rare instances, cyst may disappear spontaneously, probably by spontaneous drainage into anterior chamber. [5] In most cases, cysts are single and have round to oval configuration.…”