Conjunctival Inclusion Cyst in an 8-Year-Old

AUTHORS:
Anisha Lobo¹ • Richard Byrd, MD^2,3

AFFILIATIONS:
¹Medical Student, Texas A&M College of Medicine, Houston, Texas
²Clinical Assistant Professor, Texas A&M College of Medicine, Houston, Texas
³Pediatrician, Kelsey-Seybold Clinic, Houston, Texas

CITATION:
Lobo A, Byrd R. Conjunctival inclusion cyst in an 8-year-old. Consultant.2022;62(4):e211-e22. doi:10.25270/con.2021.08.00007

Received March 28, 2021. Accepted April 12, 2021. Published online August 18, 2021.

DISCLOSURES:
The authors report no relevant financial relationships.

CORRESPONDENCE:
Anisha Lobo, Texas A&M College of Medicine, 2121 West Holcombe Boulevard, Houston, TX 77030 (anishalobo@tamu.edu)  

An 8-year-old boy presented with his parents via a telemedicine visit with sudden onset of a cystic mass on the conjunctiva of his right eye. His parents reported that he had been having eye irritation and was rubbing his eyes when the cyst began to develop.

The patient’s only symptom at presentation was ocular itching. He had atopic dermatitis in infancy but did not have a history of seasonal allergies or asthma.

A physical examination revealed a painless, thin-walled cyst on the temporal bulbar conjunctiva of the right eye (Figure). The mass measured approximately 12 × 6 mm. 

Figure. Cystic mass on the temporal bulbar conjunctiva of the patient’s right eye

Given the patient’s isolated cystic mass on the temporal bulbar conjunctiva with known ocular irritation, a clinical diagnosis of conjunctival inclusion cyst was made.

Discussion. Conjunctival inclusion cysts are benign masses of the conjunctiva, classified as primary or secondary. Primary conjunctival inclusion cysts are present at birth and increase in size over time. They are most often found in the superior nasal bulbar conjunctiva.¹ They often involve the limbus of the eye and can progress to involve the cornea, which can result in obstructed vision.²

Secondary conjunctival inclusion cysts are more common and generally occur in adulthood.^3,4 They are caused by separation of the conjunctival epithelium caused by trauma, ocular surgery, or chronic inflammation.⁵ Ocular surgeries associated with cyst formation include strabismus repair and procedures for scleral buckling, glaucoma, and ptosis. Modern cataract surgery techniques (with incision through the cornea) pose virtually no risk of conjunctival cyst formation.⁶

Conjunctival inclusion cysts occur in equal rates between men and women of all ages.¹ Although generally asymptomatic, larger conjunctival inclusion cysts can affect vision or cause a foreign body sensation and eye pain.² Conjunctival inclusion cysts that become symptomatic do so over time, usually a period of weeks, and generally do not require emergent intervention. Surgical excision, if needed, is done electively.⁴

Conjunctival inclusion cysts are diagnosed clinically.³ Histopathologic examination of excised cysts would reveal serous fluid-containing cellular debris. The cyst wall shows layers of nonkeratinized stratified squamous epithelium with or without goblet cells. The presence of goblet cells confirms an origin in the conjunctiva, but the absence of goblet cells does not exclude conjunctival origin.⁵

Other conditions like pinguecula, pterygium, nodular scleritis, conjunctival lymphangiectasia, and phlycten should be considered when evaluating cystic masses of the conjunctiva (Table).^6-11

Secondary conjunctival inclusion cysts may spontaneously resolve but are excised if they cause significant pain or impairment of vision. Residual epithelium following excision can lead to postoperative recurrence of the cyst.⁴ Complete excision without rupture of the cyst is key to preventing recurrence.¹

Patient outcome. Our patient was managed conservatively with cool compresses and observation. Within 24 hours, his cyst spontaneously resolved. We speculated that this cyst was caused by repetitive rubbing to relieve ocular itching. A topical mast cell stabilizer was recommended for future episodes of ocular itching.

References

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