The role of entrapped cilia on the formation of lacrimal ductular cysts

We sought to describe the histopathologic features of lacrimal ductular cysts with or without inflammation and speculate on the role of cilia in their pathogenesis.

A retrospective study of 15 patients referred for lateral canthal subconjunctival cysts from 2001 to 2012 was conducted. All patients underwent cyst removal and a total histopathological examination was done. Patients were classified into 2 groups and analyzed according to their clinical and histopathologic characteristics.

Fourteen showed unilateral disease and one had bilateral disease, with a mean age of 42.8 years. Six patients had mild discomfort or no symptoms, and the remaining 9 of 15 patients presented with a symptomatic mass with conjunctival discharge and injection. Two layers of ductal epithelium constituted the whole wall of the cyst in the seven non-inflammatory cysts, three of which showed cilia in the lumen. The presence of stratified columnar epithelium with goblet cells was a peculiar feature in the lining of the nine inflammatory cases, seven of which showed cilia shafts with inflammatory cells and concrete material in the lumen. Pilosebaceous units were not evident in any of the specimens on pathologic examination.

Cilia entrapped in the lacrimal ductule may play a role in the formation of lacrimal ductular cysts with or without inflammation. Cilia falling from the eyelid may be caught in the conjunctival fornix then shift toward the horizontal lacrimal ductule in the lateral canthus. It may then serve as a nidus to provoke lacrimal ductular inflammation or cyst formation.