Ninnteen cases of forniceal subconjunctival cyst (Wolfring dacryops)

1. Hiroshi Yoshikawa¹
2. Sayaka Hirakawa¹
3. Nobuyuki Ohguro²
4. Tatsuro Ishibashi¹

¹Kyushu University
²Osaka University

Background
Wolfring dacryops, denominated by Weatherhead RG (Saudi Arabia) in 1992, is forniceal-subconjunctival cysts attaching to tarsus and lined by double-layered epithelium of accessory lacrimal gland. The aim of this study is to clarify the cause of Wolfring dacryops.

Subjects and methods
In 23 cases of forniceal-subconjunctival cyst treated in Kyushu University from 1999 to 2010, 19 cases were diagnosed as Wolfring dacryops. We carefully examined their history, clinical feature, serological and histopathological findings.

Results
The age of patients were from 3 to 75 (mean 39.4) years-old. Seven cases were male and 13 cases were female. Seven cases had 2 or more lesions in hemilateral or bilateral conjunctivas. Total 34 lesions were accompanied by conjunctival scars in transitional areas of tarsal-and forniceal conjunctivas. We devided these patients in three groups according to the age (group A: 0-29 yo, group B: 40-59yo, group C: 60-75yo.).
In 7 cases of group A, the age of 4 cases were less than 10 years, 3 cases were bilateral, and 7 of 10 lesions were situated in lower fornix. In 7 cases of group B, 3 patiensts had 3 or more lesions. A forty-two years-old woman suffering scleroderma had 5 cysts in bilateral upper and lower fornix. Three patients with the histories of acute conjunctivitis including epidemic keratoconjunctivitis were also in group B. In 5 cases of group C, 4 patients had single lesion in the central upper fornix, and 2 of them revealed to have a history of trachoma.

Conclusion
We speculate that the cause of Wolfring dacryops is neonatal chlamidial conjunctivitis in youth, acute conjunctivitis and autoimmunity in middle-aged person, and trachoma in the aged.