Case Series
Year: 2019 | Month: February | Volume: 6 | Issue: 2 | Pages: 314-318
Medial Canthal Masses Mimicking Lacrimal Sac Mucocele - A Case Series
Dr. Payal Garg1, Dr. Neeraj Agrawal2, Dr. Nidhi Pandey3
1Assistant Professor, Department of Ophthalmology, Rohilkhand Medical College, Bareilly, U.P.
2Assistant Professor, Department of General Surgery, Rohilkhand Medical College, Bareilly, U.P.
3Consultant, Orbit and Oculoplasty Services, Indira Gandhi Eye Hospital, Lucknow, U.P.
Corresponding Author: Dr. Payal Garg
ABSTRACT
Aim: To study clinico-histopathological characteristics of medial canthal masses mimicking lacrimal sac mucocele.
Materials and methods: A retrospective interventional study was conducted over a period of four years. Patients presenting with a mass in the lacrimal sac area that did not cross the medial canthal tendon and whose chief complaint was epiphora were included in the study. Patients presenting with a mass in the medial canthal region crossing the medial canthal tendon, as well as those who did not complete a minimum follow-up period of one year, were excluded. Detailed clinical data were recorded, including case notes, findings of the Regurgitation on Pressure over Lacrimal Sac (ROPLAS) test, Lacrimal Syringing in adult patients, and the Fluorescein Dye Disappearance Test (FDDT) in pediatric patients. Imaging findings, histopathological results, and clinical outcomes were also documented. All patients underwent excision biopsy through a 6–8 mm tear trough incision.
Results: A total of six patients were included in the study, with an equal male-to-female ratio (M: F = 1:1). The mean age of the patients was 22 years, ranging from 6 to 38 years. The Regurgitation on Pressure over Lacrimal Sac (ROPLAS) test was negative in all cases (100%). Syringing of the lacrimal drainage system was performed in adult patients, which revealed a patent system in one case (50%) and partial patency in the other case (50%). In pediatric patients, the Fluorescein Dye Disappearance Test (FDDT) was conducted, showing positive results in two cases (50%) and equivocal findings in two cases (50%). Imaging investigations were reserved for cases with clinical diagnostic uncertainty; Contrast-Enhanced Computed Tomography (CECT) was performed in one case, and Computed Tomography–Dacryocystography (CT‑DCG) with contrast drop technique was carried out in another case. Histopathological examination revealed that the most common lesion was an Epidermal Inclusion Cyst, identified in three cases. The remaining cases showed diverse pathologies, including Cavernous Hemangioma, Lymphangioma, and Cysticercosis, each detected in one case. These findings demonstrate a heterogeneous spectrum of underlying lesions contributing to the clinical presentation.
Conclusion: The masses in lacrimal sac area can mimic lacrimal mucocele. By causing compression effect on sac, they can present with complaint of epiphora as well. In clinical diagnostic dialemma, imaging should be done. Management changes to excision biopsy rather than conventional DCR (dacryocystorhinostomy) surgery. The histopathology reveals many variable differentials.
Key words: Lacrimal mucocele mimics, mass in medial canthal area, epiphora
[PDF Full Text]