Original Article| Volume 57, ISSUE 6, P388-393, December 2022

Dacryops and clinical diagnostic challenges



      The study aims to describe the clinical and histopathologic features of different types of dacryops and their clinical diagnostic challenges.


      This is a retrospective cohort study of all surgically excised cases of dacryops in 2 tertiary eye hospitals in Riyadh, Saudi Arabia.


      The study included 58 dacryops specimens from 55 patients with an average age of 41.2 years (range, 4–78 years). The most common location was the upper lid (60.3%), whereas the least expected location was the caruncle (6.9%). The most common site of dacryops occurrence was in the accessory lacrimal gland (55.2%), the main lacrimal gland (32.8%), and then ectopic dacryops (12%). All patients presented with lid swelling alone except for 3 patients who experienced secondary mechanical ptosis. On physical examination, conjunctival scarring existed in 4 patients (6.9%). Preoperative diagnosis of dacryops was accurate in 44.8% of the cases. Dacryops of the main lacrimal gland was accurately diagnosed clinically in all cases compared with other locations, which was statistically significant (p < 0.001). The causes of inaccurate clinical diagnoses were hidrocystoma (26.9%), inclusion cyst (11.5%), and dermoid cyst (7.7%), whereas the remaining cases were diagnosed as cysts without a specific subtype (53.9%). Recurrence of the lesion was observed in 2 cases (3.5%). No clinical or histopathologic factors were associated with a risk of recurrence.


      Dacryops can represent a diagnostic challenge to ophthalmologists. Familiarity with clinical presentations and findings is required to diagnose dacryops outside the main lacrimal gland.


      La présente étude visait à décrire les caractéristiques cliniques et histopathologiques de différents types de dacryops ainsi que leurs défis diagnostiques sur le plan clinique.


      Il s'agit d'une étude de cohorte rétrospective portant sur tous les cas de dacryops ayant fait l'objet d'une excision chirurgicale dans 2 hôpitaux de soins oculaires tertiaires à Riyad, en Arabie saoudite.


      L’étude regroupait 58 cas de dacryops provenant de 55 patients (âge moyen : 41,2 ans; fourchette : 4–78 ans). La localisation la plus fréquente était la paupière supérieure (60,3 %), tandis que la forme la plus inattendue était la caroncule (6,9 %). Les autres sièges les plus fréquents du dacryops étaient les suivants : glande lacrymale accessoire (55,2 %), glande lacrymale principale (32,8 %) et dacryops à l'extérieur de la glande lacrymale (12 %). Tous les patients présentaient un œdème de la paupière seul, à l'exception de 3 patients, qui présentaient une ptose mécanique secondaire. Lors de l'examen physique, on a noté la présence d'une cicatrice conjonctivale chez 4 patients (6,9 %). Le diagnostic préopératoire du dacryops était exact dans 44,8 % des cas. Comparativement aux autres localisations, tous les cas de dacryops touchant la glande lacrymale principale ont reçu un diagnostic clinique exact, ce qui était significatif sur le plan statistique (p < 0,001). Voici la liste des diagnostics cliniques erronés : hidrocystome (26,9 %), kyste d'inclusion (11,5 %) et kyste dermoïde (7,7 %), les autres cas ayant reçu un diagnostic de kyste aspécifique (53,9 %). Il s'est produit une récurrence de la lésion chez 2 patients (3,5 %). Aucun facteur clinique ni histopathologique n'a été associé à un risque de récurrence.


      Le dacryops peut constituer un défi sur le plan diagnostique, de sorte qu'il est important que les ophtalmologistes se familiarisent avec les présentations et caractéristiques cliniques des dacryops pour qu'ils puissent reconnaître les cas qui surgissent à l'extérieur de la glande lacrymale principale.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Canadian Journal of Ophthalmology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Eifrig CW
        • Chaudhry NA
        • Tse DT
        • Scott IU
        • Neff AG.
        Lacrimal gland ductal cyst abscess.
        Ophthalmic Plast Reconstr Surg. 2001; 17: 131-133
        • Bullock JD
        • Fleishman JA
        • Rosset JS.
        Lacrimal ductal cysts.
        Ophthalmology. 1986; 93: 1355-1360
        • Tang SX
        • Lim RP
        • Al-Dahmash S
        • et al.
        Bilateral lacrimal gland disease: clinical features of 97 cases.
        Ophthalmology. 2014; 121: 2040-2046
        • von Holstein SL
        • Therkildsen MH
        • Prause JU
        • Stenman G
        • Siersma VD
        • Heegaard S.
        Lacrimal gland lesions in Denmark between 1974 and 2007.
        Acta Ophthalmol. 2013; 91: 349-354
        • Jakobiec FA
        • Zakka FR
        • Perry LP.
        The cytologic composition of dacryops: an immunohistochemical investigation of 15 lesions compared to the normal lacrimal gland.
        Am J Ophthalmol. 2013; 155 (e1): 380-396
        • Ozgonul C
        • Uysal Y
        • Ayyildiz O
        • Kucukevcilioglu M.
        Clinical features and management of dacryops.
        Orbit. 2018; 37: 262-265
        • Tsiouris AJ
        • Deshmukh M
        • Sanelli PC
        • Brazzo BG.
        Bilateral dacryops: correlation of clinical, radiologic, and histopathologic features.
        AJR Am J Roentgenol. 2005; 184: 321-323
        • Monica M
        • Long DA
        • Karcioglu ZA.
        Bilateral dacryops.
        Ann Ophthalmol. 1988; 20 (63): 259-260
        • Shields CL
        • Shields JA
        • Eagle RC
        • Rathmell JP.
        Clinicopathologic review of 142 cases of lacrimal gland lesions.
        Ophthalmology. 1989; 96: 431-435
        • Pradhan A
        • Tripathy DD
        • Mittal R.
        Infantile simple dacryops: clinicopathological correlation and immunocharacterization.
        J AAPOS. 2020; 24: 42-46
        • Jastrzebski A
        • Brownstein S
        • Jordan DR
        • de Nanassy J.
        Dacryops of Krause gland in the inferior fornix in a child.
        Arch Ophthalmol. 2012; 130: 252-254
        • Tanaboonyawat S
        • Idowu OO
        • Copperman TS
        • Vagefi MR
        • Kersten RC.
        Dacryops: a review.
        Orbit. 2020; 39: 128-134
        • Remulla HD
        • Ad Rubin P
        Giant dacryops in a patient with ocular cicatricial pemphigoid.
        Br J Ophthalmol. 1995; 79: 1052-1053
        • Singh S
        • Shanbhag SS
        • Basu S.
        Tear secretion from the lacrimal gland: variations in normal versus dry eyes [e-pub ahead of print].
        Br J Ophthalmol. 2021;
        • Lam K
        • Brownstein S
        • Jordan DR
        • Jastrzebski A.
        Dacryops: a series of 5 cases and a proposed pathogenesis.
        JAMA Ophthalmol. 2013; 131: 929-932
        • Sacks E
        • Jakobiec FA
        • McMillan R
        • Fraunfelder F
        • Iwamoto T.
        Multiple bilateral apocrine cystadenomas of the lower eyelids: light and electron microscopic studies.
        Ophthalmology. 1987; 94: 65-71
        • Pe'er J
        Pathology of eyelid tumors.
        Indian J Ophthalmol. 2016; 64: 177-190
        • Jakobiec FA
        • Zakka FR.
        A reappraisal of eyelid eccrine and apocrine hidrocystomas: microanatomic and immunohistochemical studies of 40 lesions.
        Am J Ophthalmol. 2011; 151 (e2): 358-374
        • Lucarelli MJ
        • Ahn HB
        • Kulkarni AD
        • Kahana A.
        Intratarsal epidermal inclusion cyst.
        Ophthalmic Plast Reconstr Surg. 2008; 24: 357-359
        • AlRubaian A
        • Alkatan HM
        • Al-Faky YH
        • Alsuhaibani AH.
        Tarsal-related cysts: different diagnoses with similar presentations.
        Saudi J Ophthalmol. 2019; 33: 209-213
        • Vagefi MR
        • Lin CC
        • McCann JD
        • Anderson RL.
        Epidermoid cyst of the upper eyelid tarsal plate.
        Ophthalmic Plast Reconstr Surg. 2008; 24: 323-324
        • Majumdar M
        • Khandelwal R
        • Wilkinson A.
        Giant epidermal cyst of the tarsal plate.
        Indian J Ophthalmol. 2012; 60: 211-213
        • Min X
        • Jiang H
        • Shi L.
        Descriptive study of conjunctival cysts: a rare complication after strabismus surgery.
        J Ophthalmol. 2018; 20181076818
        • Wadhwani M
        • Kursange S
        • Singh L
        • Khanam S.
        An unusual presentation of a dermoid cyst mimicking a chalazion.
        J Pediatr Ophthalmol Strabismus. 2020; 57: e41-e42
        • Koreen IV
        • Kahana A
        • Gausas RE
        • Potter HD
        • Lemke BN
        • Elner VM.
        Tarsal dermoid cyst: clinical presentation and treatment.
        Ophthalmic Plast Reconstr Surg. 2009; 25: 146-147
        • Galindo-Ferreiro A
        • Alkatan HM
        • Muinos-Diaz Y
        • Akaishi PM
        • Galvez-Ruiz A
        • Cruz AV.
        Accessory lacrimal gland duct cyst: 23 years of experience in the Saudi population.
        Ann Saudi Med. 2015; 35: 394-399
        • Kacerovska D
        • Michal M
        • Ricarova R
        • Frdlikova D
        • Sosna B
        • Kazakov DV.
        Apocrine secretion in lacrimal gland cysts (dacryops): a common but underrecognized phenomenon.
        J Cutan Pathol. 2011; 38: 720-723
        • Eldesouky MA
        • Elbakary MA.
        Orbital dermoid cyst: classification and its impact on surgical management.
        Semin Ophthalmol. 2018; 33: 170-174
        • Jung WS
        • Ahn KJ
        • Park MR
        • et al.
        The radiological spectrum of orbital pathologies that involve the lacrimal gland and the lacrimal fossa.
        Korean J Radiol. 2007; 8: 336-342
        • Woo KI
        • Kim YD.
        Cyst of accessory lacrimal gland.
        Korean J Ophthalmol. 1995; 9: 117-121