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(a) Conjunctival cyst at the right temporal side in Case 5; (b) histopathological picture of right conjunctival cyst.
Source publication
Aim
Conjunctival cyst is one of the uncommon complications of strabismus surgery. It is important for surgeons and patients to be aware of and take precautions to minimize the risk. This study aimed to explore the clinical manifestations, etiology, and prognosis of conjunctival cyst at the operative site after strabismus surgery.
Methods
The data...
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ABSTRACT
Purpose: To assess the pain experienced by patients at the time of suture adjustment using topical proparacaine hydrochloride 0.5% anesthesia, in adjustable suture strabismus surgery.
Study Design: Prospective, interventional study.
Place and Duration of Study: Eye department of Fauji Foundation Hospital, Rawalpindi from May, 2017 to March...
The clinical features of thyroid eye disease are dictated by the orbit’s compartmentalisation; particularly, the muscle cone, which is delimited by the rectus muscles, their inter-muscular septa and the posterior sclera. The cone is anchored to the orbit apex and contains the posterior globe, the muscle bellies, a fat pad, and the blood circulation...
OCT (optical coherence tomography) is widely used in ophthalmology and pediatric ophthalmology, but limited research has been done on the use of OCT in strabismus. This study investigates the use of different OCT machines to image rectus muscle insertions pre-, intra-, and post-operatively in pediatric strabismus patients. The OCT machines used in...
Purpose
The aim of this study was to evaluate postoperative discomfort in patients undergoing ambulatory strabismus under general anesthesia, and to identify risk factors associated with the discomfort.
Patients and Methods
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We report a case of an epiretinal membrane (ERM) in a 3-year-old girl, which was accidently discovered after a strabismus surgery. The ERM occurred twice in 2 years and spontaneously released within 3 months, which has not been previously reported.
Citations
... Several case reports and case series of cyst formation after strabismus surgery have been reported in the literature [17][18][19]. The three largest series [20][21][22] included 12, seven, and six cases, respectively. Alas, a clear etiological explanation for the occurrence of postoperative cysts after strabismus surgery could not yet be found, which partly can be explained by the rarity of this complication [22,23]. ...
... Remarkably, in our collective of 822 patients, not a single cyst formation was noted during the first 4 years or within the first 410 consecutive cases, while in the second period of three and a half years or within the following 412 consecutive cases a total of 19 postoperative cysts were observed. As we pointed out in the Introduction, postoperative cyst formation is a known complication of especially strabismus surgery, but incidence in previous reports moved between 0.25% [20] and 0.4% [21], whereas it reaches an almost tenfold amount in our second collective (4.5% in the second 412 cases), and an overall value of 2.3%, which still is unparalleled. Several potential weak points make comparing those incidences difficult, the two most important being a variable rate of routine follow-up and a high variability in subjective symptoms. ...
In this work, we provide a detailed characterization of a rare complication—subconjunctival cyst formation after strabismus surgery—in a large German cohort.
We conducted a retrospective analysis of 822 consecutive patients who underwent strabismus surgery between 2015 and 2022. The patients received comprehensive eye and orthoptic examinations preoperatively, at 1 day, and at 3 months postoperatively. Cysts were analyzed with slit-lamp examination, anterior segment optical coherence tomography (AS-OCT), and histopathological subsumption.
Nineteen cases of postoperative cysts were observed (2.3%), 12 of which underwent surgical revision. Clinical evaluation including slit-lamp and AS-OCT as well as histological analysis resulted in a classification of three types of cysts: type 1, which is a single hyporeflective cyst, type 2, which is a multilobular hyporeflective cyst, and type 3, a dense hyperreflective granulomatous-like cyst. Eta (η) correlation ratio analysis could show a correlation between time of clinical appearance and type of cyst (Eta = 0.63). Most cysts developed within 20 days after surgery. Not only did cysts more frequently affect the medial rectus muscle, which in most cases underwent a shortening procedure (11/19 tucks, 4/19 resections) for intermittent exotropia (X(T)), but the cyst also formed earlier than in the lateral rectus muscle (Eta = 0.45). No correlation could be shown between the type of surgical procedure and time of cyst occurrence (Eta = 0.1). Patient age and cyst type correlated strongly (Eta = 0.47). The underlying type of strabismus did not correlate with the type of cyst observed.
Our cases showed a strong positive correlation to the type of strabismus (X(T)), age (young patients), and the procedure (tuck/resection). We introduce a grading system for postoperative cysts after strabismus surgery, complementing histopathology and slit-lamp aspects with AS-OCT information.
... Furthermore, conjunctival inclusion cysts may occur secondary to trauma or surgery and occasionally resolve spontaneously in contrast to dacryops. 23 Dermoid cysts are most commonly found attached to the frontozygomatic or frontoethmoidal sutures. However, they may be seen fixed to the tarsus. ...
Objective:
The study aims to describe the clinical and histopathologic features of different types of dacryops and their clinical diagnostic challenges.
Methods:
This is a retrospective cohort study of all surgically excised cases of dacryops in 2 tertiary eye hospitals in Riyadh, Saudi Arabia.
Results:
The study included 58 dacryops specimens from 55 patients with an average age of 41.2 years (range, 4-78 years). The most common location was the upper lid (60.3%), whereas the least expected location was the caruncle (6.9%). The most common site of dacryops occurrence was in the accessory lacrimal gland (55.2%), the main lacrimal gland (32.8%), and then ectopic dacryops (12%). All patients presented with lid swelling alone except for 3 patients who experienced secondary mechanical ptosis. On physical examination, conjunctival scarring existed in 4 patients (6.9%). Preoperative diagnosis of dacryops was accurate in 44.8% of the cases. Dacryops of the main lacrimal gland was accurately diagnosed clinically in all cases compared with other locations, which was statistically significant (p < 0.001). The causes of inaccurate clinical diagnoses were hidrocystoma (26.9%), inclusion cyst (11.5%), and dermoid cyst (7.7%), whereas the remaining cases were diagnosed as cysts without a specific subtype (53.9%). Recurrence of the lesion was observed in 2 cases (3.5%). No clinical or histopathologic factors were associated with a risk of recurrence.
Conclusion:
Dacryops can represent a diagnostic challenge to ophthalmologists. Familiarity with clinical presentations and findings is required to diagnose dacryops outside the main lacrimal gland.
... 1 Conjunctival epithelial cysts may develop congenitally, spontaneously and idiopathically, or following ocular surgery, enucleation or trauma. [2][3][4][5][6][7][8][9][10][11][12] Both surgery and trauma can cause displacement of epithelial cells into the stromal connective tissues, where they may perish or proliferate to create a cyst. The type of suture or closure material used in conjunctival surgery may play a role in cyst formation. ...
... Other surgeries for strabismus, retinal detachment and enucleation were also responsible for typical conjunctival cysts. [3][4][5][7][8][9]12,15 It should be noted that a large number of past ocular surgeries entailed a conjunctival incision and dissection that was either limbusbased or fornix-based, so that the dissection could easily detach and disperse small clusters of epithelial cells into the connective tissues (substantia propria or orbit). Despite a substantial reduction of cyst complications with more recent refined microsurgical techniques using finer or no suture material, postoperative conjunctival cysts and inadvertent filtering blebs from wound leaks 16 still occur but relatively rarely. ...
Purpose:
To document a unique case of a corneal/conjunctival epithelial inclusion cyst located in the orbicularis oculi muscle with a comprehensive review of variant conjunctival cysts and simulating conditions.
Methods:
Clinicopathologic case report with detailed histopathologic and immunohistochemical evaluation for cytokeratins combined with a tabulation of mimicking lesions and relevant literature citations.
Results:
A 59-year-old man experienced severe blunt left periorbital trauma that resulted in a limbal partial-thickness corneal wound with an associated epithelial abrasion and a full-thickness eyelid laceration extending from the superior fornix to the margin. Several months after surgical repair of the eyelid a cyst appeared in the superior pretarsal skin. Histopathologic and immunohistochemical investigations supplied data suggesting that the cyst had a high probability of a corneoscleral limbal stem cell origin. Distinctive features of the lesion are contrasted with those of allied or simulating cysts.
Conclusions:
Stem cells are now believed to be located at the corneoscleral limbus, in the inferior fornix, in the medial canthal region, and at the eyelid margin where transitions from conjunctival epithelium to epidermal epithelium occur. Due to their replicative, hardy and robust nature, stem cells displaced to alien environments are most likely to survive and produce cysts. The cyst's corneal-type cytologic characteristics, the absence of goblet cells, and the expression of a broad spectrum of cytokeratin biomarkers in the current case give support to the proposal that limbal stem cells in the region of the corneal laceration were displaced to the eyelid orbicularis muscle and were responsible for this most extraordinary cyst. Comparison with other epithelial cystic linings lends further evidence for this conclusion.
... Various factors contributing to cyst development include implantation of conjunctival epithelium in the surgical wound, infection or chronic immune reaction to sutures. 1 Ocular surgery where there is breech to the conjunctiva and sclera increase the risk of development epithelial inclusion cysts. These surgeries include strabismus surgery, retinal detachment surgery, orbital surgery and ptosis repair. ...
... 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. ...
Objective:
To report the incidence, risk factors and management of postoperative complications after horizontal strabismus surgery.
Design:
Retrospective Cohort study.
Participants:
The study assessed 1,273 patients with 1,035 cases of exotropia and 238 cases of esotropia, with a minimum 18-month follow-up.
Methods:
Retrospective review of strabismus operation patients' medical records included baseline demographics, age at surgery, pre/postoperative visual acuity, and deviation. Complications were categorized as surgical site (infection, scarring, cyst, granuloma, ischemia) and strabismus-related (recurrence, diplopia), with analysis of incidence, risk factors, and management.
Results:
Among surgical site complications, the incidence of infection, pyogenic granuloma, and anterior segment ischemia were similar between the exotropia (0.3%, 0.3%, 0.2%) and esotropia (0.8%, 0%, 0.4%) groups (p = .221, 0.406, 0.515). In contrast, the esotropia group presented a higher risk of conjunctival inclusion cyst and conjunctival scar than the exotropia group, with incidences of 5.0% vs 2.2% and 6.3% vs 1.3%, respectively (p = .004, <0.001). Regarding strabismus complications, the incidence of early recurrence was not significant between the two groups, with 10.0% in the exotropia group and 10.5% in the esotropia group (p = .553). Older age and poor initial visual acuity were associated with early recurrence (p < .001). The esotropia group had a higher risk of persistent diplopia than the exotropia group, with incidences of 4.2% vs 2.0%, respectively (p = .003).
Conclusion:
Esotropia carries a higher risk of conjunctival inclusion cysts, conjunctival scarring, and persistent diplopia compared to the exotropia group, while both groups exhibit similar rates of early recurrence and other surgical site complications.
Purpose:
To determine our rate of conjunctival cyst developing after strabismus surgery and to minimize its formation.
Materials and methods:
The data of 4026 eyes of 2662 patients were included in our retrospective analysis of, those that underwent strabismus surgery at the Beyoğlu Eye Training and Research Hospital Strabismus Unit between 2015 and 2021. Clinical characteristics and follow-up data of patients were recorded together with age, sex, and operation type. All patients were examined postoperatively on 1st day, 1st month and 6th month.
Results:
The mean age of the patients was 15.66 ± 11.81 (1-59 years). While two eyes were operated on in 1494 patients, one eye was operated on in 1168 patients. The surgeries performed were recession and/or resection of the horizontal and vertical rectus muscles and inferior and superior oblique procedures. The conjunctival cyst was detected in 11 patients postoperatively between 20 days and 8 months. The cyst was detected on the nasal side in 7 cases and temporal in 4.
Conclusion:
Conjunctival cyst is a rare complication after strabismus surgery and it is thought to be caused by a proliferation of the conjunctival epithelium. In addition to proper closure of the conjunctiva, attention to personal hygiene, avoidance of contacts that may increase suture contamination, and attention to the fact that the operation period is not long are actions that can help prevent conjunctival cyst formation.
Giant orbital cysts are a rare complication of strabismus surgery or orbital foreign body. A patient with a history of multiple surgeries presented with an orbital cyst that developed in the medial rectus muscle. Surgical exploration found a non-absorbable suture inside the cyst. The conjunctiva was closed using amniotic membrane. [J Pediatr Ophthalmol Strabismus. 2020;57:e74-e77.].
