Simple dacryops: Do we really need imaging?

Classically, dacryops have been described as an ectasia of lacrimal ductule(s) of uncertain etiology.1 In general, patients remain asymptomatic and cosmetic deformity of the lid is the usual reason for visiting an ophthalmologist.1 Being rare and simulating few other clinical conditions, many ophthalmologists are unfamiliar about this cyst and may advice unnecessary imaging. A 45-year-old female was presented with gradual painless swelling of the left upper eyelid for 2 months (Figure 1A). There was no history of trauma, inflammation, discharge, epiphora, eye surgery, or systemic illness. The patient mentioned periodic fluctuation in the size of swelling, which increased on crying or chewing. An orbital computed tomography scan orbit was advised by an ophthalmologist at another hospital 1 month earlier, which the patient refused. By then, no diagnosis was made. At present, best corrected visual acuity in both eyes was 6/6 with glasses. There was a nontender, fluctuant, tense swelling of the lateral twothirds of the upper lid leading to severe mechanical ptosis with “S”-shaped deformity of the lid. Levator action was good. There was no limitation of extraocular movements, proptosis, or globe dystopia. On partially everting the lid, a bluish-pink cystic distension of the superior fornix was noted. There was no sign of inflammation, and tear breakup time and Schirmer’s test results