CYST OF DUCT OF KRAUSE'S GLAND

Krause's accessory lacrimal gland dacryops - case report and literature review

The authors are describing two rare cases of dacryops involving the Krause accessory lacrimal glands and affecting the orbit. In both cases, the lesion was located in the inferior fornix, with no preceding trauma, surgery or trachomatous conjunctival scarring. The first case involved a clear orbital extension with evidence of optic nerve compression. The second case extended from the anterior orbit to the limbus. Both had surgical removal with good outcome. As Krause gland dacryops are similar to other orbital cysts, clinical, imaging and histopathologic evaluation are essential to confirm the final diagnosis.

Ductal cysts of the accessory lacrimal glands: CT findings

Benign ductal cysts of the accessory lacrimal glands are uncommon lesions of the orbit, arising from the glands of Wolfring and Krause. We report two patients with histopathologically proved cysts in whom CT scans revealed well-circumscribed extraconal cystic lesions adjacent to the globe, involving both eyelids. Radiologists should be aware of these rare lesions so as to include them in the differential diagnosis of orbital cysts.

Wolfring dacryops

BACKGROUND

A unique series of 13 cases of ductal cysts of the accessory lacrimal glands of Wolfring is presented. Once appreciated, they are an easily recognized clinical entity.

METHODS

The 13 cases were verified histologically as arising from ductal epithelium. Biochemical analyses for serum and cyst fluid concentrations of IgA, IgG, and IgM were performed on three of the cases. Histologic staining of the cyst wall using monoclonal antibodies to immunoglobulins was performed on one case.

FINDINGS

All patients had evidence of extensive trachomatous scarring. High levels of IgA were found in the cyst fluid, consistent with an active secretory mechanism. Monoclonal antibody staining suggested a significant role for paraductal IgA-secreting plasma cells.

CONCLUSION

The formation of a ductal cyst appears to require two successive, inter-related events. The first is an ongoing active secretory process, and the second is an occlusion of the duct. The sequential occurrence of these two events is forwarded as the explanation of dacryops formation. Excision using a conjunctival approach is recommended. A small strip of tarsal border should be removed with the cyst to prevent cyst rupture. The excretory ducts of the Wolfring glands exit through this area.

Caruncular dacryops with extruded secretory globoid bodies

A 52-year-old black man evaluated for a left cataract following an iritis was incidentally noted to have a vascularized, firm, inflammatory-appearing left caruncular mass. Removal of the cataract and of the left caruncular mass led to the discovery that the latter was composed of dilated channels containing secretory globoid bodies; the cyst wall was composed of a double layer of cuboidal epithelium, occasionally displaying apical cytoplasmic snouts. Lobules of lacrimal gland tissue were found in intimate association with the cystic spaces in multiple foci. The secretory globoid bodies had ruptured from the cystic cavity into the connective tissue of the caruncle, where a multinucleated foreign body-type granulomatous response had been elicited. This spontaneous rupture and the ensuing inflammation accounted for the inflammatory character of the lesion on clinical examination. The authors believe that secretory globoid bodies are a distinctive feature of dacryops, which normally occurs in the major lacrimal gland. When dacryops occurs in a minor lacrimal gland of the caruncle or fornices (glands of Krause or Wolfring), the presence of secretory globoid bodies may help to distinguish dacryops in these unusual locations from small conjunctival inclusion cysts, which sometimes have calcareous inclusions but lack the myriad spherical secretory bodies of dacryops.