Pre-Lacrimal Medial Canthal Epidermoid Cyst Mimicking Lacrimal Sac Dacryocystocele: An Observational Analytic Investigation of Clinico-Radiological Discordance, Functional Patency, and En Bloc Microdissection
DOI:
https://doi.org/10.37275/oaijmr.v6i5.946Keywords:
Anel test, En bloc microdissection, Epidermoid cyst, Lacrimal drainage system, Medial canthusAbstract
Background: Subcutaneous medial canthal masses present a diagnostic challenge due to their proximity to the lacrimal drainage system. Epidermoid cysts in this location are rare and frequently masquerade as dacryocystoceles or lacrimal sac tumors, risking inadvertent lacrimal instrumentation.
Objective: To characterize a medial canthal epidermoid cyst mimicking dacryocystocele and assess how functional lacrimal testing and imaging guide diagnosis and excision.
Methods: An observational-analytic single-case investigation was conducted in a 21-year-old female presenting with a painless left medial canthal mass. A diagnostic protocol integrating quantitative caliper measurements, Anel irrigation syringing, orbital contrast-enhanced computed tomography (CT), and en bloc transcutaneous microdissection was implemented with serial trajectory monitoring over 12 weeks.
Result: Physical examination revealed a 15 × 10 mm firm, mobile, non-tender subcutaneous mass superficial to the anterior lacrimal crest. Preoperative Anel syringing demonstrated 100% unobstructed patency into the nasopharynx without punctal reflux, excluding intrinsic lacrimal sac stenosis. Contrast CT revealed a 15 × 10 mm homogeneous pre-lacrimal cystic lesion (22.4 ± 4.2 Hounsfield units) with intact adjacent bone and an incidental middle cranial fossa Galassi type II arachnoid cyst. Complete en bloc surgical excision was achieved via an 8-mm skin crease incision preserving capsular integrity and the medial palpebral ligament. Histopathology confirmed an epidermoid cyst lined by mature stratified squamous epithelium containing lamellated orthokeratin without adnexa. Postoperative follow-up demonstrated complete mass resolution (Δ% = -100%), patent lacrimal outflow, and excellent cosmetic healing.
Conclusion: Functional lacrimal irrigation and high-resolution computed tomography resolve clinico-radiological discordance between pre-lacrimal epidermoid cysts and true dacryocystoceles. En bloc microdissection with capsular preservation yields definitive cure without lacrimal morbidity.
Authors
- Delvi Saswita1*
- Mardijas Efendi2
- 1Resident of Ophthalmology, Department of Ophthalmology, Faculty of Medicine, Universitas Andalas / Dr. M. Djamil General Hospital, Padang, Indonesia
- 2Reconstruction, Oculoplasty and Oncology Subdivision, Department of Ophthalmology, Faculty of Medicine, Universitas Andalas / Dr. M. Djamil General Hospital, Padang, Indonesia
Corresponding author Delvi Saswita — saswitadelvi@gmail.com
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Copyright (c) 2026 Delvi Saswita, Mardijas Efendi
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