Conjunctival Inclusion Cyst Following Closed-Globe Blunt Ocular Trauma: A Rare Complication with Spontaneous Resolution - A Case Report

Sekar Rahadisiwi; Damaryati  Widyastuti

doi:10.58344/ihj.v5i2.861

Authors

Sekar Rahadisiwi RS Mata Masyarakat Jawa Timur, Surabaya, Indonesia
Damaryati Widyastuti RS Mata Masyarakat Jawa Timur, Surabaya, Indonesia

DOI:

https://doi.org/10.58344/ihj.v5i2.861

Keywords:

conjunctival inclusion cyst, closed globe injury, blunt ocular trauma, traumatic hyphema, corticosteroid, subconjunctival haemorrhage

Abstract

Secondary conjunctival inclusion cyst is most commonly caused by ocular surgery, inflammation, and penetrating trauma. Its occurrence following closed globe blunt injury remains rarely reported. This case report aims to describe a rare presentation of a secondary conjunctival inclusion cyst developing after closed-globe blunt trauma and its successful non?surgical management with corticosteroids. A 75-year-old female on antiplatelet therapy presented with blurred vision following blunt ocular trauma from a bicycle handlebar. Examination revealed grade I traumatic hyphema, severe subconjunctival haemorrhage, and intraocular pressure of 7.6 mmHg with a negative Seidel test. Two weeks later, a 9 × 6 mm translucent cystic nodule appeared at the superior bulbar conjunctiva. Secondary conjunctival inclusion cyst was diagnosed based on clinical morphology and temporal relationship to the trauma. Complete resolution of the cyst was achieved with systemic and topical corticosteroids alone, without surgical intervention. Conjunctival inclusion cyst is a rare but possible complication of closed-globe blunt trauma. In the early post-traumatic inflammatory phase, a trial of corticosteroid therapy may represent an effective non-surgical first-line option..

References

Agrawal, R., Shah, M., Mireskandari, K., & Yong, G. K. (2013). Controversies in ocular trauma classification and management. International Ophthalmology, 33(4), 435–445. https://doi.org/10.1007/s10792-012-9698-y

American Academy of Ophthalmology. (2023). Basic and clinical science course, section 8: External disease and cornea. AAO.

Amar, P., Swamy, D. R., Selvan, H., & Chawla, R. (2017). Limbal cyst following blunt trauma in an operated case of congenital cataract: A rare scenario. BMJ Case Reports, 2017, bcr-2017-220702. https://doi.org/10.1136/bcr-2017-220702

Bagheri, A., Shahraki, K., & Yazdani, S. (2020). Trichloroacetic acid 10% injection for treatment of conjunctival inclusion cysts. Orbit, 39(2), 107–111. https://doi.org/10.1080/01676830.2019.1631358

Batchelor, A., Lacy, M., Hunt, M., et al. (2023). Predictors of long-term ophthalmic complications after closed globe injuries using the IRIS® Registry. Ophthalmology Science, 3(1), 100237. https://doi.org/10.1016/j.xops.2022.100237

Bian, Y., Stagner, A. M., & Davies, E. C. (2022). Large conjunctival epithelial inclusion cyst following scleral tunnel incision for cataract surgery. Journal of Case Reports and Images in Ophthalmology, 5, 100026Z17YB2022. https://doi.org/10.5348/100026Z17YB2022

Chen, E. J., & Fasiuddin, A. (2021). Management of traumatic hyphema and prevention of its complications. Cureus, 13(6), e15771. https://doi.org/10.7759/cureus.15771

Comez, A. T., & Arikan, S. (2022). Evaluation and management of ocular traumas. In Trauma surgery. IntechOpen. https://doi.org/10.5772/intechopen.99108

Comstock, T. L., & Decory, H. H. (2012). Advances in corticosteroid therapy for ocular inflammation: Loteprednol etabonate. International Journal of Inflammation, 2012, 789623. https://doi.org/10.1155/2012/789623

Deshmukh, S., Bhattacharjee, K., Hawaibam, S., & Gupta, K. (2018). Conjunctival inclusion cyst, an uncommon complication of a common surgery: A case report and review of literature. Advances in Ophthalmology & Visual System, 8(6), 298–299. https://doi.org/10.15406/aovs.2018.08.00325

Ding, Z. L., Zhong, C., Ying, S. R., & Wei, Y. (2012). Clinical study on hypotony following blunt ocular trauma. International Journal of Ophthalmology, 5(6), 771–774. https://doi.org/10.3980/j.issn.2222-3959.2012.06.22

Gallagher, D., Power, B., Hughes, E., & Fulcher, T. (2020). Management of orbital conjunctival epithelial inclusion cyst using trichloroacetic acid (20%) in an outpatient setting. Orbit, 39(2), 147–149. https://doi.org/10.1080/01676830.2019.1611882

Gragg, J., Blair, K., & Baker, M. B. (2025). Hyphema. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK507802/

Iftikhar, M., Mir, T., Seidel, N., et al. (2021). Epidemiology and outcomes of hyphema: A single tertiary centre experience of 180 cases. Acta Ophthalmologica, 99(3), e394–e401. https://doi.org/10.1111/aos.14603

Ioannidis, A. S., & Barton, K. (2010). Cyclodialysis cleft: Causes and repair. Current Opinion in Ophthalmology, 21(2), 150–154. https://doi.org/10.1097/ICU.0b013e3283360b4e

Kim, D. H., Khwarg, S. I., & Oh, J. Y. (2014). Atypical manifestation of conjunctival epithelial inclusion cyst: A case report. Case Reports in Ophthalmology, 5(2), 239–242. https://doi.org/10.1159/000365914

Kuhn, F., Morris, R., Witherspoon, C. D., et al. (1996). A standardized classification of ocular trauma. Ophthalmology, 103(2), 240–243. https://doi.org/10.1016/s0161-6420(96)30710-0

Küchle, M., & Naumann, G. O. (1996). Retrospective analysis of 417 cases of contusion and rupture of the globe — Erlangen Ocular Contusion Registry (EOCR) 1985–1995. Klinische Monatsblätter für Augenheilkunde, 209(5), 301–312. https://doi.org/10.1055/s-2008-1035334

Lee, C. S., Ryoo, N. K., Jun, I., et al. (2023). Closed globe and adnexal eye injuries: Epidemiology, clinical and surgical outcomes. Clinical & Experimental Ophthalmology, 51(4), 341–351. https://doi.org/10.1111/ceo.14232

Lee, P. A. L., Kono, S., Kakizaki, H., & Takahashi, Y. (2021). Conjunctival epithelial inclusion cyst following evisceration with primary orbital implantation. Case Reports in Ophthalmology, 12(2), 369–372. https://doi.org/10.1159/000514929

López-Fontanet, J. J., Ruiz, S., Torres, A. G., et al. (2024). Recurring giant conjunctival cyst effectively treated with 20% trichloroacetic acid. Cureus, 16(11), e74185. https://doi.org/10.7759/cureus.74185

Mimura, T., Usui, T., Yamagami, S., et al. (2009). Subconjunctival hemorrhage and conjunctivochalasis. Ophthalmology, 116(10), 1880–1886. https://doi.org/10.1016/j.ophtha.2009.03.030

Nurlistyani, D. P., & Lutfi, D. (2024). The challenge in diagnosis and management of secondary conjunctival cysts. Vision Science and Eye Health Journal, 4(1), 1–3.

Owji, N., & Aslani, A. (2005). Conjunctival cysts of the orbit after enucleation: The use of trichloroacetic acid. Ophthalmic Plastic and Reconstructive Surgery, 21(4), 264–266. https://doi.org/10.1097/01.iop.0000169252.22458.5e

Shields, C. L., Demirci, H., Karatza, E., & Shields, J. A. (2004). Clinical survey of 1643 melanocytic and nonmelanocytic conjunctival tumors. Ophthalmology, 111(9), 1747–1754. https://doi.org/10.1016/j.ophtha.2004.02.013

Srinivasan, S., Dollin, M., McAllum, P., et al. (2005). Conjunctival inclusion cyst following sub-Tenon's local anaesthetic injection. British Journal of Anaesthesia, 95(6), 825–826. https://doi.org/10.1093/bja/aei259

Thatte, S., Jain, J., Kinger, M., Palod, S., Wadhva, J., & Vishnoi, A. (2015). Clinical study of histologically proven conjunctival cysts. Saudi Journal of Ophthalmology, 29(2), 109–115. https://doi.org/10.1016/j.sjopt.2014.06.009

Walton, W., Von Hagen, S., Grigorian, R., & Zarbin, M. (2002). Management of traumatic hyphema. Survey of Ophthalmology, 47(4), 297–334. https://doi.org/10.1016/s0039-6257(02)00317-x

Wirbelauer, C. (2006). Management of the red eye for the primary care physician. American Journal of Medicine, 119(4), 302–306. https://doi.org/10.1016/j.amjmed.2005.08.039