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Misdiagnoses of dacryops are common, presenting difficulties for clinicians


Dacryops, or lacrimal gland cysts, vary in size and location, and often appear similar to other ocular cysts, making diagnosis difficult.

Study design

This was a retrospective study of all surgically excised cases of dacryops performed at 2 tertiary eye hospitals in Saudi Arabia. Fifty-eight specimens from 55 patients were obtained from accessory lacrimal gland, main lacrimal gland, and ectopic lacrimal gland sites and underwent histopathologic review.

Outcomes

The most common type of dacryops was accessory dacryops, leading to accurate preoperative diagnosis only 45% of the time. When the main lacrimal gland was involved, an accurate diagnosis was made in all cases. Inaccurate preoperative diagnoses included hydrocystoma (27% of cases), inclusion cyst (12%), and dermoid cyst (8%). All patients presented with eyelid swelling, regardless of the dacryops location. Those patients with atypical or deep dacryops underwent radiographic imaging, but this did not significantly improve the diagnostic accuracy. Only 2 patients had recurrence of dacryops, and there was no association between recurrence and age, gender, type or size of dacryops, presence of inflammatory cells, or any single clinical or histopathologic factor.

Limitations

The reported recurrences were too few to adequately identify risk factors for recurrence. Seven percent of patients presented with conjunctival scarring; this calls into question the previous etiology theory of ductular scarring. Although this is reportedly the largest review of different types of dacryops, and the study included histopathologic examination, the number of cases was still too small to contribute any theory for etiology.

Clinical significance

The variation of size and location of dacryops contributes to the diagnostic uncertainty, which can lead to unnecessary work-up. Oculofacial surgeons and general ophthalmologists should consider dacryops in their differential diagnosis of cysts.

Financial Disclosures: Dr. Nikisha Richards discloses no financial relationships.



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