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Dacryops and clinical diagnostic challenges

      Abstract

      Objective

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

      Methods

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

      Results

      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.

      Conclusion

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

      Objectif

      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.

      Méthodes

      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.

      Résultats

      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.

      Conclusion

      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.
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