Chist palpebral

Eyelid cyst - Types and recommendations

Chistul palpebral, inclusiv variațiile sale dermoid, folicular, etc., reprezintă afecțiuni comune ale pleoapelor, cauzate în principal de anomalii congenitale sau blocaje ale glandelor sebacee. Aceste chisturi se formează sub pielea pleoapelor, cauzând disconfort vizual și simptome neplăcute.

Tratamentul pentru chistul palpebral poate varia în funcție de mărimea și simptomele asociate, dar opțiunea preferată în multe cazuri este intervenția chirurgicală. Operația chistului palpebral oferă un rezultat rapid și eficient, eliminând chistul și restabilind aspectul și confortul pleoapelor.

1. Dermoid cyst

Dermoid and epidermoid cysts are among the most common benign orbital tumours of childhood.

These cysts are congenital and progressively enlarge. Shallower cysts usually become symptomatic in childhood, but deeper ones may not become clinically evident until adulthood. Dermoid cysts are lined by keratinising epithelium and contain dermal appendages such as hair follicles and sebaceous glands. They contain a mixture of fat and keratin. In contrast, epidermoid cysts are lined only by epidermis and are usually filled with keratin; they do not contain dermal appendages. Orbital dermoid cysts occur most commonly in the lateral brow area adjacent to the frontozygomatic suture; less commonly they may be found in the upper medial eyelid adjacent to the frontoethmoidal suture. Dermoid cysts usually present as smooth, painless, oval, palpable, slowly enlarging masses. They may be loose, mobile or may be attached by periosteum to the suture beneath. If the dermoid occurs in the temporal fossa, computed tomography (CT) is often indicated to rule out expansion into the underlying orbit. Otherwise it can cause pulsating proptosis with mastication, a very specific feature of this condition.

CT-ul este, de asemenea, util pentru a evalua leziunile mediale și pentru a distinge dermoizii de encefalocelul congenital, dacriocelul și leziunile vasculare care pot apărea și în această locație. Când este văzut pe o tomografie computerizată, un chist dermoid orbital este de obicei bine definit și are un perete intensificat și un lumen care nu se intensifică. O margine calcifiată sau parțial calcifiată este vizibilă în majoritatea cazurilor. Pe imagistica prin rezonanță magnetică apare ca o structură rotundă până la ovoidă bine definită de dimensiuni variabile. Chisturile dermoide care nu sunt vizibile până la vârsta adultă nu sunt adesea palpabile deoarece sunt situate posterior în orbită, de obicei în porțiunile superioare și temporale adiacente suturilor osoase. Globul și anexele pot fi deplasate, provocând proptoză progresivă și poate apărea eroziunea sau remodelarea osului. Chisturile dermoide de lungă durată pot eroda oasele orbitale. În unele cazuri, prezentarea clinică a chisturilor dermoide orbitale poate fi o inflamație orbitală, care este provocata de scurgerea grăsimii și a keratinei din chist. Extinderea chistului dermoid și răspunsul inflamator la scurgere pot duce la o fistulă orbitocutanată, care poate apărea și după îndepărtarea chirurgicală incompletă.

2. Management

Dermoid cysts are usually removed surgically. Because dermoid cysts that present in childhood are often superficial, they can be excised through an incision placed in the crease of the upper eyelid or directly over the lesion. If possible, the cyst wall should remain intact during surgery. Rupture of the cyst can lead to an acute inflammatory process, as can a portion of the cyst wall or any contents remaining in the eyelid or orbit. If the cyst wall is ruptured, the surgeon must remove the contents of the cyst. Complete surgical removal may be difficult if the cyst has leaked preoperatively and adhesions have developed.

3. Other benign cystic lesions

After papillomas, epidermal cysts are the second most common type of benign periocular skin lesions, accounting for approximately 18% of excised benign lesions. Most of these are epidermal inclusion cysts, which arise from the infundibulum of the hair follicle, either spontaneously or following traumatic implantation of epidermal tissue into the dermis. The lesions are slow-growing, raised, round and smooth. They often have a central pore, indicating the remaining pillar canal. Although these cysts are often called sebaceous cysts, they are actually filled with keratin. Rupture of the cyst wall can cause an inflammatory foreign body reaction. Cysts can also become infected secondarily. The recommended treatment for small cysts is excision or marsupialization, which involves excision around the periphery of the cyst but leaving the base of the cyst wall to serve as the new surface epithelium. Larger or deeper cysts may require complete excision, in which case the cyst wall must be removed intact to reduce the possibility of recurrence.

Multiple tiny epidermal inclusion cysts are called milia. They are particularly common in newborns. Generally, milia resolve spontaneously, but can be marsupialized with a blade or sharp needle. Multiple confluent milia can be treated with topical retinoic acid cream. A less common epidermal cyst is the pilar or trichilemal cyst. Such cysts are not clinically distinguishable from epidermal inclusion cysts, but tend to occur in areas containing large and numerous hair follicles. Approximately 90% of hair cysts occur on the scalp; in the periocular region they are generally found in the eyebrows. The cysts are filled with desquamated epithelium, and calcification occurs in about 25% of cases.

4. Syringomul

Benign tumours of the eccrine sweat glands commonly found in young females, syringomas present as multiple small, waxy, prominent nodules 1-2 mm in diameter on the lower eyelids. Syringomas may also be found in the axillary and sternal region. They become more obvious during puberty. Because the eccrine glands are located in the dermis, these lesions are too deep to allow shaving excision. Removal requires complete surgical excision. A less common variant, chondroid syringoma, occurs most commonly in middle-aged men and can grow up to 3 cm. It is composed of components of the sweat gland in a mixed cartilaginous stroma.

5. Hydrocystoma

It is a benign cyst of the sweat glands. It can be eccrine or apocrine, single or multiple.

6. The echrin hydrocystoma

Eccrine hydrocystomas are common cystic lesions 1-3 mm in diameter that occur in clusters and tend to clump around the lower eyelids, corners and face. They are considered to be ductal retention cysts and often enlarge in conditions such as heat and increased humidity, which stimulate sweating. Treatment consists of surgical excision.

7. The apocryphal hydrocystoma

A very common, smooth cyst arising from the Moll's glands along the edge of the eyelid, apocrine hydrocystoma is considered to be an adenoma of Moll's secretory cells rather than a retention cyst. These lesions are usually translucent or bluish and transilluminating. They may be multiple and often extend deep beneath the surface, especially in the canthal regions. Treatment of superficial cysts is marsupialization. Deep cysts require complete excision of the cyst wall.

Go for a check-up immediately if you notice an abnormally increased mass to have a correct differential diagnosis and rule out serious cancerous lesions.

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- 13th December 2022

Palpebral cyst