A simple transconjunctival technique for the management of intraconal orbital hydatid cyst

Abstract

Purpose: To present a simple transconjunctival technique for the excision of intraconal orbital hydatid cysts.

Methods: This retrospective, non-comparative, clinical intervention case study was conducted between April 2018 and October 2023. The study included five patients presented to the Orbital unit of Assiut University Hospital with an intraconal orbital cyst, which histologically proved to be a hydatid cyst. In all cases, a conjunctival incision near the fornix was made depending on the cyst location as revealed by computed tomography (CT) or magnetic resonance imaging (MRI). A traction suture was applied to the two relevant recti muscles to guide the globe toward the desired direction. Blunt orbital dissection was made toward the cyst until exposing its anterior surface. A 20-gauge needle was introduced into the cyst and followed by aspiration of its content. The collapsed cyst was then removed by non-toothed forceps and followed by copious irrigation of the field. The follow-up period ranged from 11 to 58 months.

Results: The age of patients ranged from 11 to 44 years. Three were males and two were females. The cyst was iso-dense to the vitreous on CT and iso-intense to the vitreous on MRI. In all cases after aspiration of the content, the collapsed cyst was easily removed. None of the five patients developed recurrence during the follow-up period.

Conclusion: The removal of the collapsed orbital hydatid cyst in the intraconal space after the aspiration of its content via transconjunctival anterior orbitotomy is a simple, fast technique with early recovery and maximum cosmesis.

Figure 1

(case 2). Surgical steps of transconjunctival excision of intraconal hydatid cyst: (a) Conjunctival incision over the inferotemporal quadrant of the orbit with traction sutures applied to the inferior and lateral recti for traction of the globe superonasally, (b) dissection between the globe and the tenon’s capsule until reaching the intraconal space with exposure of the anterior surface of the cyst (arrow), (c) aspiration of the content of the cyst using a 20-gauge needle to cause the cyst to collapse (arrow), (d) grasping the cyst wall with non-toothed forceps and removal of the cyst in one piece, (e) removal of the traction sutures and closure of the conjunctiva 8–0 vicryl sutures

Figure 2

(case 2). (a) Preoperative gross image of the patient showing left-sided axial proptosis, (b) Coronal T1-weighted MRI disclosing hypointense intraconal cyst (long arrow) inferior to the optic nerve (short arrow), (c) sagittal T1-weighted MRI disclosing that the cyst (arrow) is isointense to the vitreous, (d) gross image of the patient after excision of the cyst with complete resolution of proptosis

Figure 3

(case 4). (a) Preoperative gross image of the patient showing left-sided proptosis, (b) axial CT disclosing retrobulbar cyst (arrow) that is iso-dense to the vitreous, (c) Gross image of the removed cyst, (d) Postoperative gross image of the patient showed complete resolution of proptosis with minimal subconjunctival hemorrhage

Figure 4

(case 1). (a) Preoperative gross image of the patient showing right-sided proptosis, (b) Coronal CT disclosing cyst (long arrow) inferonasal to the optic nerve (short arrow), (c) postoperative gross image of the patient showing lower fornical conjunctival prolapse, (d) postoperative gross image of the patient after resolution of the conjunctival prolapse