Unilateral eye irritation
An otherwise healthy 27-year-old woman presented to her primary care clinic with a 2-week history of itchiness and foreign body sensation in her right eye. She denied any history of eye trauma, pain, discharge, or redness to the eye.
What’s your diagnosis?
Physical examination revealed an irregularly shaped conjunctival cyst on the lateral (temporal) field of the right eye. (This diagnosis is usually made based on the clinical examination alone.)
Primary care physicians encounter patients with a variety of eye conditions; pruritis and foreign body sensation are among the most common complaints.1 While viral or allergic conjunctivitis is often to blame for “itchy eyes,” the cause can also be a conjunctival mass.
Conjunctival masses can be divided into 2 groups: solid tumors or cysts.2 Conjunctival cysts form due to trauma, infection, or inflammation that disrupts the conjunctival epithelium. They can be congenital or acquired (more common) and are rarely caused by over-the-counter eye drops.2,3 The differential diagnosis for a conjunctival cyst includes conjunctival bleb, pinguecula, pterygium, pyogenic granuloma, and tumors of the conjunctiva. An external eye exam plus a slit-lamp examination can help confirm the diagnosis.
Small, asymptomatic conjunctival cysts will mostly resolve on their own and can be managed conservatively with lubricating eye drops.3 When inflammation surrounds the cyst, short-term use of a mild topical corticosteroid is reasonable.2 Simple needle aspiration can be performed but may lead to recurrence of the cyst. Lesions larger than 15 mm, or those that have grown or changed, should be evaluated by an ophthalmologist for biopsy and further management.2,3
After a discussion of the benefits and risks of different approaches, this patient decided on conservative management. Supportive care with lubricating eye drops was started. At her 1-month follow-up, all symptoms had resolved.
Photos courtesy of Morteza Khodaee, MD, MPH. Text courtesy of Amy S. Li, MD, Department of Internal Medicine, Jennifer Cogburn, MD, and Morteza Khodaee, MD, MPH, Department of Family Medicine, University of Colorado School of Medicine, Denver