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S. J. Haug, M. K. Yoon, T. Hwang, M. M. Bloomer, T. J. McCulley; Clinical and Histopathologic Assessment of Post-Chalazion Excision Tarsal Epidermal Cysts. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3519.
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To describe clinical and pathologic features of post-chalazion excision tarsal epidermal cysts (PETEC)
Using the computer database, four patients (3 males; mean age 54, range 49 to 60) who developed epithelial lined cysts arising from the tarsus were identified. Medical records were reviewed for clinical and microscopic findings.
All four patients presented with progressively enlarging subcutaneous eyelid masses. Each PETEC was well demarcated, non-tender, and mobile anteriorly with posterior tethering to the tarsus. Diameters ranged from 5 to 15 mm. Each patient had previously been managed for an inflamed eyelid lesion and assigned the diagnosis of chalazion based on clinical findings. Initial lesions were all managed by outside physicians. All had undergone at least one or more incision and drainage procedures via a conjunctival tarsal incision. One patient had 12 incision and drainage procedures performed over the course of 30 years. In all cases, following drainage, the PETEC developed without associated inflammation. For removal, each PETEC was exposed via an eyelid crease incision. Each was well circumscribed and easily dissected from the surrounding soft tissue. The cyst linings were firmly adherent to the tarsus with a full thickness defect resulting from complete excision, which was performed in all cases. Cutaneous incisions were closed with a single layered running stitch. Tarsal defects were not repaired. Microscopically all PETEC were epithelial lined. One was similar to conjunctiva, two contained components of keratinized and mucosal epithelium and one was composed of keratinized stratified epithelium. In one case, bacteria were present in the contents of the cyst. None have recurred with follow-up periods ranging from 6 to 36 months.
Post-chalazion excision tarsal epidermal cysts (PETEC) may follow incision and drainage of a chalazion. We theorize that conjunctival epithelial ingrowth occurs at the site of tarsal incision. Varying degrees of squamous metaplasia might account for the differences in the microscopic appearance of the cyst lining. An alternative hypothesis is that PETEC arise de novo. Regardless of their pathophysiology, all PETEC were successfully managed with complete excision.
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