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Clinicopathologic Reports, Case Reports, and Small Case Series |

An Ectopic Site of Lacrimal Gland Secretion Mimicking Epiphora FREE

Timothy J. McCulley, MD; Chee-Chew Yip, MD; Robert C. Kersten, MD; Dwight R. Kulwin, MD
Arch Ophthalmol. 2002;120(11):1586-1587. doi:.
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Epiphora, starting at or shortly after birth, is most commonly associated with obstruction of the lacrimal drainage system. It may also be due to reflex hypersecretion secondary to ocular irritation, such as that caused by glaucoma, trichiasis, and infectious or chemical conjunctivitis. We present an additional cause of congenital tearing, an ectopic lacrimal gland ductule opening on the external upper eyelid at the lateral canthus, mimicking epiphora.

A healthy 8-year-old white male was evaluated for tearing of the right eye, which started within 3 months of birth. The excess tears were noted to run down the lateral aspect of the right eye. Abnormal tearing of the left eye had not been observed. Epiphora was frequent, and when most severe, was associated with environmental irritants, such as dust or sand. There was no additional complaint of ocular irritation or other symptom.

On examination, several hairs, identical in appearance to adjacent eyelashes, were present 3 mm above the lateral edge of the lash line of the right upper eyelid. With applied corneal irritation, tears were noted to originate from the same cutaneous ostium as the ectopic lashes and to run down the patient's cheek (Figure 1). No baseline secretion from the aberrant opening was observed during examination. Ophthalmic examination results were otherwise within normal limits, with a best-corrected visual acuity of 20/20 OU, normal corneal examination results, normal and equal tear lakes, no palpable palpebral or orbital lacrimal gland mass, no exophthalmos, and normal ocular motility. Ocular tear production, estimated with filter paper saturation, was normal and equal in both eyes. The lacrimal drainage system was patent; dye disappearance testing and irrigation were normal and equal in both eyes. On general physical examination, the patient was healthy, with no additional congenital abnormalities. The patient declined surgical excision for control of symptoms.

Place holder to copy figure label and caption

Ectopic eyelashes and lacrimal gland secretion site (arrow) with tear directed lateral to the right eye (arrowheads).

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To our knowledge, this is the first reported case of abnormal tear drainage due to lacrimal gland secretion through a lacrimal ductule misdirected to the external eyelid. Excessive tearing was most severe in association with ocular irritants, when reflex tearing would be maximal. There was no evidence of additional lacrimal system abnormalities. The patient had a healthy cornea, normal tear lake, and normal measured tear production.

This most likely represents a developmental abnormality. Other possible lesions that might contain glandular tissue, such as a teratoma or dermoid tumor, are unlikely in the absence of a palpable mass and do not produce tears. Although not associated with epiphora, cases have been reported of ectopic lacrimal glandular tissue and duct cysts.14 Moreover, misdirected lacrimal gland secretion through a congenital aberrant lacrimal gland ductule is supported by the presence of the observed neural link with lacrimal gland secretion, evidenced by an association of secretion with ocular irritation and the lack of secretion in its absence. In short, secretion from an ectopic lacrimal gland ductule should be considered when evaluating patients with congenital epiphora.

The authors do not have any commercial or proprietary interest in any materials or techniques mentioned in this article.

Corresponding author and reprints: Timothy J. McCulley, MD, Department of Ophthalmology, University of California–Irvine, 118 Med Surge I, Irvine, CA 92697-4375 (e-mail: tmcculle@uci.edu).

Boccato  PBlandamura  SMidena  ECarollo  C Orbital ectopic lacrimal gland tissue simulating a neoplasm: report of a case with fine needle aspiration biopsy diagnosis. Acta Cytol. 1992;36737- 743
Kao  SCYeh  LKTsai  CCHsu  WM Ectopic lacrimal gland cyst of the orbit. Chung Hua I Hsueh Tsa Chih (Taipei). 2000;63334- 338
Rush  ALeone  CR  Jr Ectopic lacrimal gland cyst of the orbit. Am J Ophthalmol. 1981;92198- 201
Von Domarus  H A lacrimal gland cyst in the orbit. J Craniomaxillofac Surg. 1987;15106- 109
Link to Article

Figures

Place holder to copy figure label and caption

Ectopic eyelashes and lacrimal gland secretion site (arrow) with tear directed lateral to the right eye (arrowheads).

Graphic Jump Location

Tables

References

Boccato  PBlandamura  SMidena  ECarollo  C Orbital ectopic lacrimal gland tissue simulating a neoplasm: report of a case with fine needle aspiration biopsy diagnosis. Acta Cytol. 1992;36737- 743
Kao  SCYeh  LKTsai  CCHsu  WM Ectopic lacrimal gland cyst of the orbit. Chung Hua I Hsueh Tsa Chih (Taipei). 2000;63334- 338
Rush  ALeone  CR  Jr Ectopic lacrimal gland cyst of the orbit. Am J Ophthalmol. 1981;92198- 201
Von Domarus  H A lacrimal gland cyst in the orbit. J Craniomaxillofac Surg. 1987;15106- 109
Link to Article

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