Rare case of a conjunctival cyst formation in an anophthalmic socket of a 10 years old patient

Evisceration is a widely performed surgery in the pediatric population, the most common etiology for children is trauma and malignant retinal tumors. The procedure is safe and the complications are rare and often easily manageable.

We report the case of a 10 years old male patient, who had undergone evisceration surgery of the right eye 2 years before his admission, following a penetrating ocular trauma. The trauma circumstances were reported as accidental knife perforation. The patient was hospitalized and beneficiated from sutures of the globe injuries, associated to parenteral and local fortified antibiotics treatments. The follow-up was marked by installation of chronic painful endophthalmitis that was managed with an evisceration and hydroxyapatite implant. Two years later, the ophthalmic examination revealed the presence of 2 conjunctival cysts underneath the prosthesis, with no exteriorization of the hydroxyapatite implant. A surgery was then performed with removal of the conjunctival cysts.

Introduction

Evisceration is a widely performed surgery in the pediatric population, the most common etiology for children is trauma and malignant retinal tumors [1,2]. The procedure is safe and the complications are rare and often easily manageable [3,4]. The most common complications are prolonged pain and swelling, hemorrhage, necrosis, cellulitis, extrusion of the implant and sympathetic ophthalmia [5-7].

We report the case of a 10 years old male patient, who had undergone evisceration surgery of the right eye 2 years before his admission, following a penetrating ocular trauma.

The trauma circumstances were reported as accidental knife perforation. The patient was hospitalized and beneficiated from sutures of the globe injuries, associated to parenteral and local fortified antibiotics treatments. The follow-up was marked by installation of chronic painful endophthalmitis that was managed with an evisceration and hydroxyapatite implant. The patient then received an ocular prosthesis and was not reporting any symptoms for the following year. Two years later, the patient suffered from chronic bacterial conjunctivitis in the same eye that was not responding to usual treatments. The ophthalmic examination revealed the presence of 2 conjunctival cysts underneath the prosthesis, with no exteriorization of the hydroxyapatite implant (Figure 1,2). A surgery was then performed with removal of the conjunctival cysts, reconstruction of the conjunctival shell covering the implant and the anatomical piece was then sent to pathology for examination (Figure 3). Histopathologic analysis revealed the epithelial downgrowth nature of the excised piece.

To our knowledge, this is the first reported case of an epithelial downgrowth in an anophthalmic socket in a child. Our literature review found few reported cases only, all of which occurred in adults [8-10].

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© 2018 Ould Hamed MA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.