Lacrimal Intrasaccal Cyst

Dear Editor, Two cases with epiphora and medial canthal mass showed a cyst within the lacrimal sac that compressed the lacrimal drainage system. We describe a new lacrimal sac anomaly of lacrimal intrasaccal cyst, which has not yet been reported. A 31-year-old woman was referred for epiphora in her left eye for 17 years. She also presented with a 10-year history of a palpable mass below the medial canthal tendon. The lacrimal system was patent on irrigation. In computed tomographic (CT) dacryocystography (DCG), a soft ovoid mass of 25 mm was found in the lacrimal sac fossa, and the lacrimal passage was compressed and deviated anteriorly (Fig. 1A and 1B). DCG revealed a patent but laterally deviated lacrimal drainage passage (Fig. 1C). After subciliary incision, an enlarged lacrimal sac was identified and dissected. After lacrimal sac incision, serous fluid gushed out from a blind sac on the periosteal side of the lacrimal sac. The internal common punctum and the lateral lacrimal sac wall were identified after excision of the lateral wall of the cyst. The cyst and the lacrimal sac shared a common wall along the entire length between them. External dacryocystorhinostomy was performed after cyst excision. Histopathologic study revealed a cyst wall lined with pseudostratified columnar and cuboidal epithelium, supporting the finding of the lacrimal sac mucosa (Fig. 1D). The patient has now been free of symptoms for five years. A 39-year-old man was referred for epiphora of two-year duration. A soft mass was found just above the left medial canthal tendon. In the CT-DCG, a 16 mm-sized soft tissue mass was identified with pressure remodeling of the adjacent bone (Fig. 1E). The DCG revealed a deviated and Korean J Ophthalmol 2015;29(6):433-434 http://dx.doi.org/10.3341/kjo.2015.29.6.433 Correspondence