Korean J Ophthalmol.  2012 Aug;26(4):297-300. 10.3341/kjo.2012.26.4.297.

Multilobular Lacrimal Sac Diverticulum Presenting as a Lower Eyelid Mass

• Kim JH
• Chang HR
• Woo KI

• KMID: 1387398
• DOI: http://doi.org/10.3341/kjo.2012.26.4.297

Abstract

Lacrimal sac diverticulum is a rare condition, and its various symptoms complicate differential diagnosis. We present cases of a peculiar type of lacrimal diverticulum. A 5-year-old girl and a 50-year-old woman presented with a protruding mass inferior to the medial canthus. Each lacrimal system was patent to irrigation. The masses compressed and distorted the lacrimal passage and had no apparent connection with the lacrimal sac in dacryocystography or computed tomography. Surgical exploration and complete excision of the masses were completed. Each patient had an inverted Y- and an inverted V-shaped multilobular cystic mass that was pathologically confirmed as a lacrimal sac diverticulum. Lacrimal sac diverticula may rarely take the form of a multilobular cyst and can present as a lower lid mass. We speculate that an abnormality in lacrimal embryogenesis resulted in multiple blind pouches, a peculiar type of lacrimal sac diverticulum.

Keyword

Diverticulum; Lacrimal cyst; Lacrimal sac; Multilobular

MeSH Terms

Child, Preschool
Diagnosis, Differential
Diverticulum/radiography/*surgery
Eyelids/radiography/surgery
Female
Humans
Lacrimal Apparatus Diseases/radiography/*surgery
Middle Aged
Tomography, X-Ray Computed

Figure

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  Fig. 1 Case 1. (A) A mass was found along the right inferior orbital rim (arrows). (B) Dacryocystography was performed. A reconstructed image of an inverted Y-shaped mass (white line): the lateral lobule extended along the inferior orbital rim, the inferior lobule pushed the nasolacrimal duct medially (arrow), and the superior lobule displaced the lacrimal sac both anteriorly and laterally. There was no dye outflow across the lacrimal sac wall. (C) Dacryocystography of the left side. (D) Coronal computed tomography (CT): a soft tissue mass surrounded by rim enhancement (arrows). (E) Axial CT: air density (arrowhead) of the lacrimal sac was displaced anteromedially by the mass (arrows). The lacrimal sac fossa was widened. (F) Epithelium of the mass consisted of pseudo-stratified cuboidal and columnar epithelium. The wall of the mass consisted of fibroblasts and collagen fibers (H&E, ×100).

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  Fig. 2 Case 2. (A) A lower eyelid mass fixed along the inferior orbital rim (arrows) with overlying skin erythema. (B) Dacryocystograph of the right side: a reconstructed image of an inverted V-shaped mass (white line) next to the right lacrimal sac and nasolacrimal duct. The mass was compressing the lacrimal sac and nasolacrimal duct (arrow). (C) Dacryocystograph of the left side. (D) Coronal computed tomography (CT): a soft tissue mass (arrows) compressed the lacrimal sac at the level of the medial canthus. (E) Axial CT: a high density inside the mass (arrow) at the level of the upper part of the nasolacrimal duct indicated dacryolithiasis at the inferior lobule of the diverticulum.

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