• Written By: Matthew W. Wilson, MD, FACS
    Ocular Pathology/Oncology

    The authors performed a retrospective clinicopathologic study of the immunohistochemistry of 15 dacryops (lacrimal duct cyst) specimens and compared the findings with normal lacrimal glands. The study's findings discount theories of dysfunction of neuromuscular contractility as the etiology of dacryops and support an alternative theory of periductular inflammation and scarring.

    Clinical data from 14 patients were reviewed and microscopy was performed with routine stains and immunohistochemical probes for epithelial membrane antigen (EMA), gross cystic disease fluid protein-15 (GCDFP-15), cytokeratin 7 (CK7) and smooth muscle actin (SMA).

    Thirteen lesions arose from the major lacrimal gland and two arose from the accessory lacrimal gland of Krause. One case was bilateral. The average age of the patients was 50.7 years. Neither visual acuity nor motility was disturbed. No lesion recurred after excision.

    They were able to identify goblet cells and pseudo-apocrine apical cytoplasmic projections in all dacryops specimens. Lacrimal acinar cells immunoreacted with both GCDFP and CK7, whereas normal ductal epithelium and the epithelium of the dacryops reacted only with CK7. SMA stained myoepithelial cells in the acini but did not stain normal ductal epithelium or the epithelium of the dacryops.

    The authors conclude that negative GCDFP-15 staining ruled out apocrine metaplasia in dacryops. Normal ducts and dacryops showed no immunohistochemical evidence for the presence of myoepithelial cells. A dysfunction of the rich neural plexus around the ductules may play a role in the development of dacryops in conjunction with periductular inflammation and induced scarring.

    The authors add that the most common palpebral lobe cases of dacryops preferably should be managed by judicious local excision that carefully avoids transecting the ducts of the deeper orbital lobe that pass through the superficial palpebral lobe to empty into the superolateral fornix of the conjunctival sac.