Pictorial case study: Swelling on the eye

The case: A 69-year-old woman presented to the surgery as several members of her family had commented on the presence of a small swelling on the nasal aspect of her left eye over the previous two weeks.

The patient had a small swelling on the nasal aspect of her left eye (Photograph: SPL)
The patient had a small swelling on the nasal aspect of her left eye (Photograph: SPL)

The patient could also see it when looking in the mirror and was aware of it when looking to the right. Her vision was otherwise unaffected and she had no pain or irritation associated with the small swelling.

On examination there was a 0.5cm round raised clear swelling on the conjunctiva of her left eye. The conjunctiva appeared otherwise normal and examination of her eye revealed no other problems.

Diagnosis and management
The diagnosis was a conjunctival cyst, which is a thin-walled sac containing fluid. It contains a collection of tear components. It may be on or just under the conjunctiva and may occur following chronic irritation of the conjunctiva or be secondary to dry eye syndrome. In addition, cysts may occur following trauma to the eye or after surgery.

Treatment is not always necessary as the condition is harmless and the cyst may resolve spontaneously. In this patient's case, the cyst persisted and she requested treatment.

She was referred to an ophthalmic surgeon who initially incised the cyst in the clinic. The cyst reformed after the incision so the ophthalmic surgeon excised the cyst. There was no recurrence after excision.

Possible differential diagnoses

  • Pterygium.
  • Conjunctival haemangioma.
  • Limbal dermoid.

Differential diagnosis

Pterygium

  • Pterygium is a benign growth over the sclera, which occurs as a result of fibrovascular proliferation.
  • It is generally fan-shaped and occurs over the nasal aspect of the sclera.
  • It is thought to be due to exposure to sun and wind and occurs more frequently near the equator.
  • It is harmless and only requires treatment if it is encroaching on vision.

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