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Giant epidermal cyst of the tarsal plate.

Majumdar M, Khandelwal R, Wilkinson A - Indian J Ophthalmol (2012 May-Jun)

Bottom Line: Excisional biopsy with tarsectomy was done.Histopathology sections demonstrated a keratin-filled cyst arising from the tarsus.A thorough Pubmed search did not reveal an epidermal cyst of the tarsal plate of this size which was successfully managed.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, NKPSIMS & Lata Mangeshkar Hospital, Nagpur, Maharashtra, India.

ABSTRACT
A 35-year-old male patient presented with a right upper eyelid mass with mechanical ptosis. The patient gave no history of trauma or surgery. On examination, there was a huge cystic mass fixed to the tarsal plate. Excisional biopsy with tarsectomy was done. Histopathology sections demonstrated a keratin-filled cyst arising from the tarsus. A thorough Pubmed search did not reveal an epidermal cyst of the tarsal plate of this size which was successfully managed. The incision was made in such a way that postoperative ptosis would be avoided. Excess skin was removed during the surgery.

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10th postoperative day showing normal levator function
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Figure 5: 10th postoperative day showing normal levator function

Mentions: A 35-year-old male patient presented with a swelling of the right upper eyelid of 10 years’ duration. The swelling which was initially the size of a peanut started increasing in size since the last 1 year, causing drooping of the upper eyelid. There was no associated pain or redness. There was no history of ocular trauma, previous surgery or any systemic illness. On examination, there was a mechanical ptosis with zero vertical interpalpebral fissure height and zero levator function. The lid showed a large round swelling of 2 cm in diameter [Fig. 1]. On palpation, the tumor was well defined, cystic but firm, and free from skin and bony margins. There were no signs of inflammation and the overlying skin appeared normal. On retraction of the upper eyelid, only 2 mm of the lower cornea was seen which appeared normal [Fig. 2]. The left eye examination was normal. Computed tomography (CT) scan of the right orbit did not reveal any bony attachments on bone and soft tissue window. There were no cysts elsewhere like on face, neck and trunk, and rest of the systemic examination was also normal. The patient was posted for excisional biopsy. A horizontal skin incision was made, inferior to the lid crease. Subcutaneous tissue was separated from the center toward periphery. Careful superior and inferior separation of the cyst from subcutaneous tissue was done [Fig. 3]. Inferiorly, the cyst had reached the lid margin as the hair follicles were visible during dissection. As the dissection proceeded posteriorly, the cyst was found to be attached to the tarsal plate. Hence, a 3–4 mm tarsectomy was done to remove the cyst in toto [Fig. 4]. The tarsoconjunctival suturing was done with 8-0 Vicryl. Excess skin was excised and skin was sutured with interrupted sutures using Proline. The patient was started on oral antibiotics and anti-inflammatory drugs. There was lid edema on the 1st postoperative day. He was started on topical antibiotics. By the 10th postoperative day, the edema had totally subsided, the levator function had returned to normal and there was no ptosis [Fig. 5]. The patient has shown no recurrence in the follow-up period of 5 months and has a best corrected vision of 20/30 post surgery. Histopathology reports showed, on gross appearance, a round to oval 2.5 × 2 × 2 cm cystic, grayish-brown mass. Microscopy revealed a cyst lined by stratified squamous epithelium devoid of keratohyaline granules. The cyst lumen contained string-like keratin [Figs. 6 and 7]. The cyst wall was composed of bland collagenous tissue devoid of inflammation. Part of the tarsal plate and the underlying conjunctiva was attached to the cyst wall. The histopathologic features were consistent with epidermal cyst of the tarsal plate.


Giant epidermal cyst of the tarsal plate.

Majumdar M, Khandelwal R, Wilkinson A - Indian J Ophthalmol (2012 May-Jun)

10th postoperative day showing normal levator function
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3361817&req=5

Figure 5: 10th postoperative day showing normal levator function
Mentions: A 35-year-old male patient presented with a swelling of the right upper eyelid of 10 years’ duration. The swelling which was initially the size of a peanut started increasing in size since the last 1 year, causing drooping of the upper eyelid. There was no associated pain or redness. There was no history of ocular trauma, previous surgery or any systemic illness. On examination, there was a mechanical ptosis with zero vertical interpalpebral fissure height and zero levator function. The lid showed a large round swelling of 2 cm in diameter [Fig. 1]. On palpation, the tumor was well defined, cystic but firm, and free from skin and bony margins. There were no signs of inflammation and the overlying skin appeared normal. On retraction of the upper eyelid, only 2 mm of the lower cornea was seen which appeared normal [Fig. 2]. The left eye examination was normal. Computed tomography (CT) scan of the right orbit did not reveal any bony attachments on bone and soft tissue window. There were no cysts elsewhere like on face, neck and trunk, and rest of the systemic examination was also normal. The patient was posted for excisional biopsy. A horizontal skin incision was made, inferior to the lid crease. Subcutaneous tissue was separated from the center toward periphery. Careful superior and inferior separation of the cyst from subcutaneous tissue was done [Fig. 3]. Inferiorly, the cyst had reached the lid margin as the hair follicles were visible during dissection. As the dissection proceeded posteriorly, the cyst was found to be attached to the tarsal plate. Hence, a 3–4 mm tarsectomy was done to remove the cyst in toto [Fig. 4]. The tarsoconjunctival suturing was done with 8-0 Vicryl. Excess skin was excised and skin was sutured with interrupted sutures using Proline. The patient was started on oral antibiotics and anti-inflammatory drugs. There was lid edema on the 1st postoperative day. He was started on topical antibiotics. By the 10th postoperative day, the edema had totally subsided, the levator function had returned to normal and there was no ptosis [Fig. 5]. The patient has shown no recurrence in the follow-up period of 5 months and has a best corrected vision of 20/30 post surgery. Histopathology reports showed, on gross appearance, a round to oval 2.5 × 2 × 2 cm cystic, grayish-brown mass. Microscopy revealed a cyst lined by stratified squamous epithelium devoid of keratohyaline granules. The cyst lumen contained string-like keratin [Figs. 6 and 7]. The cyst wall was composed of bland collagenous tissue devoid of inflammation. Part of the tarsal plate and the underlying conjunctiva was attached to the cyst wall. The histopathologic features were consistent with epidermal cyst of the tarsal plate.

Bottom Line: Excisional biopsy with tarsectomy was done.Histopathology sections demonstrated a keratin-filled cyst arising from the tarsus.A thorough Pubmed search did not reveal an epidermal cyst of the tarsal plate of this size which was successfully managed.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, NKPSIMS & Lata Mangeshkar Hospital, Nagpur, Maharashtra, India.

ABSTRACT
A 35-year-old male patient presented with a right upper eyelid mass with mechanical ptosis. The patient gave no history of trauma or surgery. On examination, there was a huge cystic mass fixed to the tarsal plate. Excisional biopsy with tarsectomy was done. Histopathology sections demonstrated a keratin-filled cyst arising from the tarsus. A thorough Pubmed search did not reveal an epidermal cyst of the tarsal plate of this size which was successfully managed. The incision was made in such a way that postoperative ptosis would be avoided. Excess skin was removed during the surgery.

Show MeSH
Related in: MedlinePlus