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Eye Cancer Network Case #6: Giant Conjunctival Inclusion Cysts
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Digital Slit-lamp Photograph - Case 2: A digital slit-lamp photograph of a pigmented conjunctival tumor in the superonasal quadrant. The anterior, superior, inferior, and posterior margins are visible. The episcleral margin is obscured by the tumor.
History: Two subconjunctival masses appearing 45 (Case 1) and
7 (Case 2) years after surgery.
 Digital Slit-lamp Photograph - Case 1: A digital slit-lamp photograph of a conjunctival cyst overlying the insertion of the lateral rectus muscle. The anterior, superior and inferior margins are clearly visible. The posterior and episcleral margins are not visible. There is also a question as to the involvement of the lateral rectus muscle.
Impression: Giant Conjuctival Inclusion Cysts
Comment: Conjunctival cysts typically cause cosmetic defects and Case 1, prevented proper eyelid closure. Since most are excised, high frequency ultrasound can help define the tumors extent. In Case 2, it differentiated between a solid and cystic pigmented conjunctival tumor.
Case 1: High-frequency ultrasound revealed that the lateral rectus muscle was not incarcerated within the tumor and defined the posterior tumor margin. The sclera was found to be intact. This was expected, but not known by slit-lamp examination. These findings were helpful for pre-operative planning.
High Frequency Ultrasound - Case 1: High-frequency ultrasound reveals a cyst overlying an intact sclera (arrow). The entire scleral surface in contact with the cyst was scanned. The lateral rectus muscle was not found to be incarcerated in the cyst. The cyst edges were well circumscribed.
Case 2: This tumor was more ominous looking. It was cystic, pigmented and close to the lacrimal gland. Again, high-frequency ultrasound was used to delineate the tumor's edges, confirm scleral integrity, and that it was a cyst.
High Frequency Ultrasound - Case 2: High frequency ultrasound reveals extremely low internal reflectivity in the center with some particulate matter within. The sclera was progressively scanned and found to be intact. The tumor edges were circumscribed.
These cases were presented to aid in your continued care of patients with conjunctival cysts. Next time you plan excision of a large conjunctival cyst, you may want to consider evaluating it with a high-frequency ultrasound.
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