Conjunctival cysts
👁️ Conjunctival Cysts
🔍 Definition
A conjunctival cyst is a fluid-filled sac on or under the conjunctiva. It may be congenital or acquired, and while usually benign and painless, it can cause irritation, foreign body sensation, or cosmetic concern.
🧬 Types of Conjunctival Cysts
| Type | Cause | Location |
|---|---|---|
| Retention cyst | Blocked duct of a conjunctival gland | Bulbar or palpebral conjunctiva |
| Inclusion cyst | Post-surgical or post-traumatic (epithelial implantation) | Often at incision or injury site |
| Lymphatic cyst (lymphangiectasia) | Dilated lymphatic channels | Can be diffuse or multilocular |
| Parasitic cyst | Rare – due to parasitic infection (e.g., cysticercosis) | Subconjunctival |
🧠 Etiology (Causes)
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Congenital – developmental anomaly
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Trauma – accidental or surgical (e.g., post strabismus surgery)
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Infections – e.g., trachoma, inclusion conjunctivitis
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Allergic conjunctivitis – chronic rubbing and inflammation
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Obstruction of ducts – e.g., of Krause or Wolfring glands
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Post-inflammatory – chronic conjunctivitis
👀 Clinical Features
| Feature | Description |
|---|---|
| Appearance | Clear, dome-shaped blister-like lesion |
| Location | Most commonly bulbar conjunctiva (visible part of the white of the eye) |
| Symptoms | Often asymptomatic; can cause: |
| - Foreign body sensation | |
| - Redness or irritation | |
| - Dry eye feeling (if large or irritating cornea) | |
| Mobility | Often mobile on palpation (unless subconjunctival) |
| Translucency | Translucent to transparent; may contain mucus or serous fluid |
🩺 Diagnosis
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Clinical – based on slit-lamp exam
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Fluorescein staining – may show pooling if cyst is superficial
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OCT or ultrasound biomicroscopy (UBM) – in atypical cases
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Histopathology – if removed, to confirm type (especially if recurrent)
💊 Management
| Approach | Description |
|---|---|
| Observation | If small, asymptomatic, and not growing |
| Needle aspiration | Temporary relief, but high recurrence rate |
| Surgical excision | Definitive treatment, esp. for recurrent or large cysts |
| Laser ablation | Sometimes used (e.g., Nd:YAG) |
| Cryotherapy | Rarely used now |
⚠️ Surgery should aim to completely excise the cyst wall to prevent recurrence.
⚠️ Differential Diagnosis
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Pinguecula
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Conjunctival papilloma
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Dermoid cyst
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Conjunctival melanoma (if pigmented or atypical)
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Lymphangiectasia (multiple cystic spaces)
🧠 Quick Summary Table
| Feature | Conjunctival Cyst |
|---|---|
| Common types | Retention, inclusion, lymphatic |
| Symptoms | Usually asymptomatic or mild discomfort |
| Appearance | Clear, dome-shaped, fluid-filled lesion |
| Causes | Trauma, post-surgery, chronic inflammation |
| Diagnosis | Clinical, slit-lamp |
| Treatment | Observation, needle aspiration, or excision |
| Recurrence | Possible if cyst wall not fully removed |
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