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Purpose: To report the features of the rare and under-recognized condition of canaliculops (or canaliculocele) of the eyelid, which is a dilation of the canaliculus, and to evaluate treatment with marsupialization., Design: Retrospective interventional case series., Methods: The records of 2 patients with canaliculops from the Massachusetts Eye and Ear Infirmary were reviewed. Data collected included clinical history, surgical technique, histopathologic analysis, and comparative immunohistochemical analysis of a range of cytokeratins in normal conjunctival epithelium, normal canalicular epithelium, and canaliculops epithelium., Results: Two women, 53 and 66 years of age, experienced chronic, noninflammatory, painless medial eyelid and eyelid margin fluctuant swelling after earlier trauma or eyelid surgery. The external mass was accompanied by a whitish opalescent or bluish discoloration of a palpebral surface bulge. Biopsy revealed multilaminar (up to 12 cells thick), nonkeratinizing, tightly packed small squamous epithelial cells that surmounted a highly regimented basal layer with a picket fence arrangement. No goblet cells or subepithelial inflammation were present. Immunohistochemistry revealed only superficial CK7 immunostaining and positive patchy suprabasilar CK17 staining in the canaliculops epithelium, contrasting with their full-thickness positivity and negativity, respectively, in normal conjunctival epithelium. Marsupialization achieved resolution of the condition in each patient., Conclusions: An improved awareness of the normal canalicular epithelial structure and its immunohistochemical features can definitively separate canaliculops from conjunctival cysts. Previous treatment of canaliculops has involved complete excisions. Canaliculops may, however, be effectively treated with less invasive marsupialization while obtaining an adequate biopsy specimen for histopathologic diagnosis., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: To define the cytologic composition of the double-layered epithelial lining of dacryops (lacrimal duct cyst), improve histopathologic diagnosis, and better understand pathogenesis., Design: Clinicopathologic retrospective study with immunohistochemical studies of 15 lesions compared with normal lacrimal gland., Methods: 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)., Results: The major lacrimal gland was involved in 13 lesions; 2 lesions arose in an accessory 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 was discovered to have recurred after excision. Microscopically, in all dacryops specimens goblet cells and luminal pseudoapocrine apical cytoplasmic projections were identified. Lacrimal acinar cells immunoreacted with GCDFP-15 and CK7, whereas the normal ducts and the epithelium of the dacryops lesions reacted diffusely only with CK7. SMA-positive myoepithelial cells were found in the acini but not in the normal ducts or dacryops epithelium., Conclusions: Negative GCDFP-15 staining ruled out apocrine metaplasia in dacryops. Normal ducts and dacryops showed no immunohistochemical evidence for the presence of myoepithelial cells. Pathogenetic theories of dacryops that implicate a failure of ductular "neuromuscular" contractility must therefore be revised. 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., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: To describe a rarely reported complication of strabismus surgery., Design: Observational case series., Methods: A review of four eyes in three patients with orbital cysts following strabismus surgery., Results: Each patient had either a symptomatic strabismus or visible mass that brought them to medical attention many years, often decades after surgery (mean 34 years). All had some degree of incomitancy. During surgery, all cysts were found to be associated with the involved rectus muscle., Conclusions: Orbital cysts are a rarely recognized complication of strabismus surgery. However, it should be considered in the differential of orbital cysts after strabismus surgery because of the risk of muscle damage during surgical excision.

Purpose: To report the use of a combination of transpupillary argon laser photocoagulation and Nd:YAG laser cystotomy in the treatment of peripheral iris pigment epithelium (IPE) cyst., Design: Case report., Methods: A 23-year-old man presented with a one-month history of blurred vision and pain in the right eye. Slit-lamp biomicroscopy and gonioscopy revealed, in the iridociliary sulcus, a large clear IPE cyst, which was demonstrated by ultrasound biomicroscopy (UBM). A combination of transpupillary photocoagulation to devitalize the epithelial lining and neodymium-doped yttrium aluminum garnet (Nd:YAG) laser cystotomy to drain the cyst was engaged., Results: Laser treatment resulted in vanishing of the cyst and disappearance of the subject symptoms. Two months postoperatively, no evidence existed of the iris pigment cyst regrowth., Conclusions: The minimal invasiveness of the combination of transpupillary laser photocoagulation and cystotomy yielded a favorable result. This procedure may be an alternative to conservative regimen if IPE cyst is clearly defined and readily seen.

Purpose: To report a case of migration of liquid silicone into the upper eyelid., Design: Interventional case report., Methods: A 32-year-old woman had an injection of liquid silicone into the subcutaneous tissue of the forehead. She developed a cystic mass in the upper eyelid 2 days postinjection. An excisional biopsy was performed., Results: The mass lay in the Müller's muscle, and its base adhered to the tarsus. The mass ruptured during dissection, revealing a yellowish turbid fluid. Histopathologic findings showed lipogranulomatous reaction., Conclusions: Liquid silicone injection to the forehead may promote formation of a cystic mass in the upper eyelid.

Purpose: To review management strategies for treatment of anterior chamber epithelial cysts., Design: Retrospective review of consecutive interventional case series., Methods: Charts of patients treated for epithelial ingrowth over a 10-year period by a single surgeon were reviewed. Cases of anterior chamber epithelial cysts were identified and recorded, including details of ocular history, preoperative and postoperative acuity, intraocular pressure (IOP), and ocular examination, type of surgical intervention, and details of further procedures performed., Results: Seven eyes with epithelial cysts were identified. Patient age ranged from 1.5 to 53 years at presentation. Four patients were children. In four eyes, cysts were secondary to trauma, one case was presumably congenital, one case developed after corneal perforation in an eye with Terrien's marginal degeneration, and one case developed after penetrating keratoplasty (PK). Three eyes were treated with vitrectomy, en bloc resection of the cyst and associated tissue, fluid-air exchange and cryotherapy. The last four eyes were treated with a new conservative strategy of cyst aspiration (three cases) or local excision (one keratin "pearl" cyst), and endolaser photocoagulation of the collapsed cyst wall/base. All epithelial tissue was successfully eradicated by clinical criteria; one case required repeat excision (follow-up, 9 to 78 months, mean 45). Two eyes required later surgery for elevated IOP, two for cataract extraction and one for repeat PK. Final visual acuity ranged from 20/20 to hand motions, depending on associated ocular damage. Best-corrected visual results were obtained in the more conservatively managed eyes., Conclusions: Anterior chamber epithelial cysts can be managed conservatively in selected cases with good results. This strategy may be particularly useful in children's eyes, where preservation of the lens, iris, and other structures may facilitate amblyopia management., (Copyright 2003 by Elsevier Science Inc.)

Purpose: To report a case of recurrent epithelial inclusion cyst of the iris treated with needle aspiration and endodiathermy., Methods: Case report. A 27-year-old man with a history of congenital cataracts, congenital nystagmus, cataract surgery in each eye at 3 years of age, and a long-standing iris epithelial cyst presented with decreased vision of 20/400 in the better seeing left eye. The reduced vision was diagnosed secondary to growth of the iris inclusion cyst over the pupil., Results: The iris cyst, which occluded the chamber angle and pupil, was treated with aspiration, separation of the cyst wall from the cornea, and endodiathermy. Twelve months after cyst surgery, no evidence existed of epithelial cyst regrowth. The visual function was significantly improved, although Snellen visual acuity was unchanged at 20/400., Conclusion: The minimal invasiveness of needle aspiration and diathermy can result in a satisfactory outcome without undertaking more extensive and invasive surgical treatments for epithelial inclusion cysts of the anterior chamber.

Purpose: To report the clinical history and surgical management of recurrent congenital iris stromal cyst., Method: Case report. Argon laser endophotocoagulation and cryotherapy were used to treat a recurrent iris stromal cyst in an 18-month-old boy., Results: At 43 months of follow-up, there was no recurrence or evidence of epithelial ingrowth., Conclusion: Treatment with argon laser endophotocoagulation and cryotherapy resulted in complete resolution of a recurrent congenital iris cyst.

Purpose: To investigate optical coherence tomography images of spontaneous macular hole closure., Method: Case report. In a 60-year-old woman with full-thickness macular hole, posterior vitreous detachment, and previous branch retinal vein occlusion, we observed the entire course of spontaneous macular hole closure by use of optical coherence tomography., Results: Spontaneous macular hole closure began as the inward protrusion of the tissue around the margin of the macular hole. The protruding tissue then connected to bridge the macular hole, which mimicked a foveal retinal detachment. The bridged tissue gradually thickened, and the foveal detachment and perifoveal cysts resolved. The fovea eventually regained its normal configuration., Conclusions: The bridging of the protruding retinal tissue over the macular hole plays a key role in spontaneous macular hole closure.

Purpose: To compare the incidence of encapsulated bleb after trabeculectomy in eyes with and without previous argon laser trabeculoplasty and to assess other risk factors for encapsulated bleb development., Methods: After medical treatment failure, eyes enrolled in the Advanced Glaucoma Intervention Study (AGIS) were randomly assigned to sequences of interventions starting with either argon laser trabeculoplasty or trabeculectomy. In the present study we compared the clinical course for 1 year after trabeculectomy in 119 eyes with failed argon laser trabeculoplasty with that of 379 eyes without previous argon laser trabeculoplasty. Data on bleb encapsulation were collected at the time that the encapsulation was diagnosed, and 3 and 6 months later., Results: Of multiple factors examined in the AGIS data for the risk of developing encapsulated bleb, only male gender and high school graduation without further formal education were statistically significant. Encapsulation occurred in 18.5% of eyes with previous argon laser trabeculoplasty failure and 14.5% of eyes without previous argon laser trabeculoplasty (unadjusted relative risk, 1.27; 95% confidence limits = 0.81, 2.00; P = .23). After adjusting for age, gender, educational achievement, prescribed systemic beta-blockers, diabetes, visual field score, and years since glaucoma diagnosis, this difference remains statistically not significant. Four weeks after trabeculectomy, mean intraocular pressure was 7.5 mm Hg higher in eyes with (22.5 mm Hg) than without (15.0 mm Hg) encapsulated bleb; at 1 year after trabeculectomy and the resumption of medical therapy when needed, this excess was reduced to 1.4 mm Hg., Conclusions: This study, as did two previous studies, found male gender to be a risk factor for bleb encapsulation. Four studies, including the present study, have reported a higher rate of encapsulation in eyes with previous argon laser trabeculoplasty; in two of the studies, one of which was the present study, the rate was not statistically significantly higher; in the other two studies the rate was significantly higher. The 4-week postoperative mean intraocular pressure was higher in eyes with than without encapsulated bleb; with the resumption of medical treatment the two means converged after 1 year.

Purpose: To report the incidence and sector distribution of ciliary body cysts in normal subjects and to assess association with age using ultrasound biomicroscopy., Methods: We prospectively examined 232 eyes of 116 normal subjects (51 men and 65 women) ranging in age from 15 to 84 years (mean +/- SD, 45.2 +/- 20.1). Complete ophthalmic examination, including gonioscopy and ophthalmoscopy with mydriasis, was performed. In addition, the circumference of the ciliary body was divided into eight sectors, and scanned in transverse and radial sections by high-resolution ultrasound biomicroscope to determine the incidence, distribution, and location of cysts., Results: Based on one randomly chosen eye from each subject, cysts were detected in 63 (54.3%) of the 116 subjects. Cysts were found most frequently and in greater numbers in the inferior and temporal sectors. The incidence and the distribution range, expressed as the number of involved sectors per eye, were 73.1% and 3.8, respectively, for subjects 20 approximately 29 years old; both incidence and the number of involved sectors decreased with age (P = .0001). Cyst diameter ranged from 200 to 2500 microm; mean size decreased with age (P = .001). Gender and refractive error did not affect the incidence and distribution. There was significant bilateral correlation in the number, incidence, and distribution of ciliary body cysts., Conclusion: Ultrasound biomicroscopy disclosed a high incidence of ciliary body cysts in normal subjects, which decreased with age. Cysts were multiple and bilateral in many subjects.

Purpose: To report an adverse side effect associated with topical latanoprost usage., Method: Case report. A 76-year-old woman with primary open-angle glaucoma developed an iris cyst 5 weeks after beginning treatment with latanoprost. Clinical examinations and slit-lamp photographs were performed., Results: Latanoprost was discontinued. Periodic examinations disclosed that the iris cyst gradually diminished and finally disappeared within 3 weeks., Conclusion: The formation of an iris cyst is a possible complication of topical latanoprost therapy.

Purpose: To report a case of congenital intrascleral epithelial cyst., Method: Case report., Results: A 3-year-old boy presented with a limbal cyst noticed at birth. The cyst enlarged over the next 3 1/2 years and dissected into the cornea, compromising the visual axis. Excision of the cyst improved the patient's best-corrected visual acuity in the left eye from 20/80 to 20/30. Upon histopathology, the cyst wall was lined by conjunctival epithelium., Conclusion: This congenital intrascleral epithelial cyst later enlarged and dissected into the cornea. We believe that the cyst developed secondary to congenital sequestration of conjunctival epithelium.

Purpose: To report the clinical appearance and course of intrastromal clefts occurring with acute hydrops in keratoconus., Methods: In eight patients with bilateral keratoconus, nine eyes developed acute corneal hydrops complicated by intrastromal cleft formation. One patient developed this complication in both eyes. The patients, three female and five male, had a mean age of 20 years (range, 11 to 36 years) and were followed after onset of acute hydrops for a median of 8 months (range, 2.5 to 21 months). The patients in this retrospective study were identified and had been treated at one of two institutional cornea referral practices., Results: In eight of nine eyes with intrastromal clefts, complete cleft closure occurred between 6 weeks and 6 months. In one eye, cleft closure was nearly complete in a patient followed up for only 4.5 months after onset of hydrops. Corneal stromal neovascularization developed in six of the nine of eyes. At the last follow-up visit, four of the six untreated eyes had a best-corrected visual acuity of 20/200 or worse. The patient with intrastromal clefts in both eyes did not develop stromal neovascularization and achieved a contact lens corrected visual acuity of 20/40 or better in each eye without surgical intervention., Conclusions: Intrastromal cleft formation is a manifestation of corneal hydrops in keratoconus. Single or multiple clefts can occur, and bilateral involvement is possible. Clefts generally close over a period of months, but stromal neovascularization is common and may compromise future graft survival.

Purpose: To report corneal abnormalities associated with incontinentia pigmenti., Case Reports: Two girls, aged 2 1/2 and 5 years, with incontinentia pigmenti from one family underwent a complete ophthalmic examination., Results: We found vortex (whorl-like) epithelial keratitis characterized by epithelial microcysts that stained with fluorescein and midstromal radial mild haziness in daughters of a family with incontinentia pigmenti., Conclusion: Incontinentia pigmenti should be included in the differential diagnosis of children with keratitis, particularly if there is evidence of characteristic dermatologic or other systemic manifestations.

Purpose: To report a case of a cystic ciliary body melanoma that appeared clinically as a solid mass., Methods: A 59-year-old woman underwent an iridocyclectomy for removal of a ciliary body melanoma in the right eye. The tumor was analyzed histopathologically for acid mucopolysaccharide production., Results: Histopathology identified a ciliary body melanoma with cystic cavities. Contents of the cystic spaces did not stain with alcian blue. Histologic findings suggested exudation, cavitary necrosis, or both rather than acid mucopolysaccharide production as pathogenic factors for cyst formation., Conclusion: Cystic cavities can develop in a solid, malignant tumor and therefore should not be considered signs of a benign lesion.

Purpose: To describe the spontaneous collapse of primary acquired iris stromal cysts., Methods: We reviewed the medical records, clinical findings, and ultrasonography of two patients who had been followed up for primary acquired iris stromal cysts., Results: During follow-up, both patients experienced spontaneous collapse of their cysts, which resulted in membrane formation on the peripheral corneal endothelium, localized peripheral anterior synechiae, ectropion uveae, and slightly peaked pupil., Conclusion: Primary acquired iris stromal cysts may undergo spontaneous collapse, resulting in clinical findings similar to other anterior segment disorders.

Purpose: We studied a case of Fuchs' superficial marginal keratitis in which cystic corneal hydrops developed in one eye, and spontaneous corneal perforation occurred in the fellow eye., Methods: The patient underwent bilateral annular corneoscleral lamellar patch grafts for tectonic support., Results: The patient had an uncomplicated postoperative course and visual acuity of 20/25 bilaterally., Conclusion: Stromal loss in Fuchs' superficial marginal keratitis may be severe enough to result in cystic corneal hydrops. Patients with this disorder should be counseled regarding the possibility of corneal perforation.

Purpose: We sought to clarify the morphologic features of macular hole development., Methods: Using scanning laser ophthalmoscopy, we examined 47 eyes with macular holes before and after vitrectomy. Cases included three eyes with stage 1B disease (foveal detachment), 14 with stage 2 (break at the fovea), 21 with stage 3 (full-thickness macular hole), and nine with stage 4 (detached operculum), according to Gass's classification. Ten eyes with central serous chorioretinopathy served as controls., Results: Radiating striae of Henle's fibers were seen around the elevated rim of the macular cyst or hole when the intraretinal structures were illuminated by helium-neon laser. Granularity was observed on the macular hole floor. A granular reflex corresponding to the macular break or hole, but no radiating striae were seen by argon blue laser. In 40 eyes in which macular holes were successfully closed by vitrectomy, radiating striae of Henle's fiber layer disappeared, and the normal foveal depression was restored. The ten eyes with central serous chorioretinopathy had a normal foveolar depression and no detectable radiating striae of Henle's fiber layer, despite full-thickness retinal detachment in the macular area., Conclusions: Tractional elevation of Henle's fiber layer with intraretinal foveolar cyst formation is the initial feature of macular hole development. A macular hole is formed when the anterior cyst wall containing Henle's fiber layer is operculated. Remnants of the photoreceptor cell layer remain on the hole floor in the early stage of macular hole development and subsequently degenerate.

Purpose: Primary cysts of the iris pigment epithelium frequently appear to be focal elevations of the peripheral iris. To differentiate them from other anterior segment tumors requires the ability to assess the distribution, tissue characteristics, and progression of such lesions, which we accomplished by using anterior segment echography., Methods: We reviewed the medical records of 49 consecutive patients referred to the Doheny Eye Institute for echographic evaluation of focal bulging of the peripheral iris. Echography of the anterior segment was performed on each patient by using an immersion technique. Clinical examination was also performed on 20 (41%) patients at the time of initial examination., Results: We identified 52 iris pigment epithelial cysts in 52 eyes of the 49 patients studied. All lesions were single, localized to the posterior iris surface, and demonstrated a well-circumscribed, echolucent structure on B-scan echography. Average maximal sagittal thickness was 1.6 +/- 0.4 mm. Cysts were most frequently located in the inferotemporal quadrant (31%). Minimal increase in size or regression of lesions was noted in the nine patients (ten eyes) for whom follow-up echographic examinations were available., Conclusions: Primary iris pigment epithelial cysts possess characteristic features with regard to location, size, and internal structure, which can be accurately documented with echography. Clinically evident lesions tend to be between 1 and 4 mm in maximum sagittal thickness, conform to the contour of posterior chamber structures without distortion, produce anterior bulging of the peripheral iris, are preferentially located in the inferotemporal quadrant, and demonstrate limited potential for growth.

Purpose/methods: Computed tomographic scan disclosed a well-defined mass in the right lacrimal fossa of a 57-year-old woman. We excised and examined the mass., Results/conclusions: The mass was a combination of a small benign mixed cell tumor and a large ductal cyst of the lacrimal gland. It is possible that a cyst in the lacrimal duct may mask an underlying neoplasm of the lacrimal gland.

We managed three cases of congenital iris stromal cysts and compared them with 22 cases in the published reports to delineate the clinical features of this condition and determine the best treatment. Our first patient, a 5-month-old girl, had injection of a cyst with trichloroacetic acid, but developed a cataract and endothelial damage to the cornea and the eye was eventually enucleated. Our second patient, a 9-week-old girl, was treated with repeated xenon photocoagulation, drainage of the cyst, and cryotherapy, but required enucleation of the eye. Our third patient, a 5-month-old girl, had excision of the cyst by sector iridectomy with preservation of vision and no recurrence two years later. Our results suggest that complete surgical excision is a superior method of treatment for congenital cysts of the iris stroma.

Five family members and three unrelated patients (four women, four men, 23 to 71 years old) had a dystrophy of the corneal epithelium. Direct slit-lamp examination showed bilateral or unilateral, gray, band-shaped, and feathery opacities that sometimes appeared in whorled patterns. Retroillumination showed intraepithelial, densely crowded, clear microcysts. Light and electron microscopy disclosed diffuse vacuolization of the cytoplasm of epithelial cells in the affected area. Visual acuity was so reduced in three patients that abrasion of the corneal epithelium was performed. The corneal abnormalities recurred within months, with the same reduction in visual acuity as before. The corneal opacities were progressive in two patients but diminished noticeably in another after he began using a hard contact lens. We found no other ophthalmic irregularities or associated systemic abnormalities and no indication of drug-induced keratopathy.

Two patients with massive epithelium-lined inclusion cysts of the orbit became symptomatic five and 16 years after scleral buckling. Each patient described diplopia and displacement of the previously treated eye. An orbitotomy in the first patient disclosed a loculated epithelium-lined inclusion cyst that extended posteriorly from the insertion of the inferior rectus muscle nearly to the apex of the orbit. In the second patient, a loculated epithelium-lined inclusion cyst extended into the superior nasal portion of the orbit from its origin near the insertions of the superior and medial recti muscles. We speculated that epithelial cells of the conjunctiva were shed at the time of scleral buckling and became lodged in the exposed sulcus created by the surgical retraction of Tenon's capsule. Here they proliferated and formed the large epithelium-lined cysts. In each patient, removal of the cyst was followed by a decrease in diplopia as the displaced globe returned toward its normal position.

A 32-year-old black man had a deeply pigmented anterior uveal lesion that was indenting and subluxing the lens. The mass was successfully removed by a sector iridectomy and diagnosed histologically as an adenoma of the iris pigment epithelium. Although this rare tumor is sometimes misdiagnosed clinically as a malignant melanoma or iris cyst, it has distinctive clinical features which should differentiate it from these other entities.

We studed the clinical and histopathologic findings in two congenital iris cysts, one in a 19-month-old girl and one in a 7-year-old boy. Our second case showed the resilience of these lesions, with the cyst returning to its original size after needle aspiration, argon iridotomy, marsupialization, and excisional iridotomy. Cryogenic therapy was needed to eliminate the cyst. In both cases, histologic studies showed squamous epithelium with few (Case 1) or no (Case 2) goblet cells.

A 33-year-old man, 28 years after enucleation for a perforating injury, had a four-year history of slowly progressive proptosis of his prosthesis. Examination revealed a spherical mass filling the space normally occupied by the globe. A cyst lined by conjunctival epithelium was encountered on surgical exploration.

Three patients had microphthalmos with cyst in one orbit and contralateral congenital cystic eye, microphthalmos alone, or microphthalmos with cyst. Four eyes were examined histopathologically. The microphthalmic eye demonstrated a spectrum of anterior segment abnormalities, retinal disorganization and gliosis, and a choroidal and scleral colomboma. The cyst connected to the colobona consisted of an outer fibrovascular layer and inner gliotic neuroectodermal layer. The cyst probably originated from proliferation of neuroectodermal tissue at the edge of a persistently open embryonic fissure. Treatment consisted of multiple aspirations of the cyst, excision of the cyst alone, and excision of both the microphthalmic eye and cyst.

A case-control study of 78 white patients with primary cysts of the iris was undertaken. Two control groups were established for comparison with the subjects. Contingency tables were used to evaluate the distribution of iris color among subjects and controls. Statistical testing (chi 2) indicated no significant association of iris color with the presence of a primary iris cyst (P greater than .05). These results indicated that primary iris cysts do not exhibit the association with light iris color previously documented for iris melanocytic lesions.

An infant with bilateral congenital microphthalmos with cyst developed neurologic and cardiac abnormalities that resulted in her death at the age of 7 months. When she was first examined, the cystic masses in both eyes transilluminated and were easily deformable. No ocular structures could be identified. Bilateral microphthalmos with cyst appears to be associated with major systemic abnormalities whereas unilateral microphthalmos with cyst is associated with much less serious systemic abnormalities.

We reviewed 57 consecutive biopsies of lesions of the caruncle seen in the Wills Eye Hospital Pathology Department from 1977 through 1985. The types and relative frequency of excised caruncular lesions were recorded and correlation of pathologic diagnosis with preoperative clinical diagnosis, age, and sex was made. Squamous papillomas accounted for 18 (32%) and nevi for 14 (24%) of all caruncular masses. Pyogenic granulomas accounted for five (9%), epithelial inclusion cysts for four (7%), chronic inflammation for four (7%), and oncocytomas for two (4%) of all caruncular masses. Of the 57 cases only three (5%) were malignant tumors.

Ectopic lacrimal gland tissue is most common in the eyelid, conjunctiva, and cornea, but may also be found in the uvea or orbit. A 7-year-old boy developed a mass in the anterior superiomedial orbit close to the trochlea. A superior medial orbitotomy, done when the boy was 9 years old, disclosed a tense, thin-walled, fluid-filled cyst containing a small nest of normal lacrimal gland with a large capsule of fibrous tissue containing areas of singly layered epithelial cells.

A grossly cystic retinoblastoma, presumably a form of the diffuse infiltrating type, mimicked uveitis in an 81/2-year-old boy. A review of 44 cases indicated that grossly (clinically) detectably cysts are rare in this neoplasm, although microcysts are relatively common. Lesions of this nature, especially if presenting with a history of trauma, as in our patient, may lead the ophthalmologist to diagnose uveitis. The diagnosis of retinoblastoma may thus be unduly delayed.

A 33-year-old man had a unique lens capsular cyst that became clinically evident eight years after a penetrating ocular injury in which the lens capsule was disrupted. Microscopic examination indicated that the cyst may have arisen from displaced lens capsule and epithelial cells that became separated from the lens.

Hematic cyst of the orbit has been described in association with various diseases, but its pathogenetic mechanism remains unclear. We treated two patients (two men, 38 and 35 years old) who had growing cysts suspected of being malignant tumors. Surgical exploration of the orbits disclosed birefringent crystals (hematodin) either in the cyst wall or in the cyst's contents. The crystals imitated foreign bodies in their appearance and in the reactions they induced.

A 43-year-old woman had a history of gradual unilateral visual acuity loss and proptosis. A 2.5-cm cystic dilatation of the intraorbital dura mater was removed. Microscopic examination revealed a vascular proliferation within the leptomeninges. We inadvertently injected the lesion during orbitography, providing us with an unusual radiographic appearance.