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Complete Excision of a Simple Dacryops Using Fibrin Sealant and Trypan Blue Mixture

Men, Clara J., M.D.*; Yang, Patrick, M.D.*; Gur, Zvi, M.D.*; Paik, Ji-Sun, M.D., Ph.D.*; Kikkawa, Don O., M.D., F.A.C.S*,†; Korn, Bobby S., M.D., Ph.D., F.A.C.S.*,†

Ophthalmic Plastic & Reconstructive Surgery: January/February 2019 - Volume 35 - Issue 1 - p e16–e18
doi: 10.1097/IOP.0000000000001283
Case Reports

A 69-year-old woman presented to the oculofacial plastic service with a painless superotemporal subconjunctival mass in the OS. Over the past year, the lesion had been progressively enlarging, resulting in horizontal diplopia with lateral gaze. Visual acuity was within normal limits with no evidence of optic neuropathy. On examination, the lesion was tense, transilluminated, and was clinically consistent with a simple dacryops. Complete excision of the lesion was planned under local anesthesia with monitored care. To facilitate complete removal of the lesion, fibrinogen and a mixture of thrombin and trypan blue were injected to fill the cyst cavity. This blue-stained fibrin clot allowed for easy visualization of the border and ensured complete excision without collateral damage to surrounding normal tissue. Simple dacryops is often difficult to remove completely with its capsule intact and this technique allows for clear delineation of the cyst and preservation of epithelial integrity for complete and efficient removal.

A case report of a 69-year-old woman with a superotemporal orbital mass consistent with a simple dacryops, with complete excision performed using fibrin sealant mixed with trypan blue.

*Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology

Division of Plastic Surgery, Department of Surgery, UC San Diego, La Jolla, California, U.S.A.

Accepted for publication October 22, 2018.

The authors have no financial or conflicts of interest to disclose.

Address for correspondence and reprint requests to Bobby S. Korn, M.D., Ph.D., F.A.C.S., UCSD Department of Ophthalmology, 9415 Campus Point Drive, La Jolla, CA 92093. E-mail:

© 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.