Conjunctival cyst in a case of chronic vernal keratoconjunctivitis

An 8 years old boy had a 3-year history of vernal keratoconjunctivitis (VKC) on topical therapy (Loteprednol etabonate 0.5% eyedrops, Bepotastin besilate 1.5% eyedrops, and Tacrolimus 0.1% topical ointment) with a gradually enlarging, painless swelling in the right eye for 1 month. There was no history of trauma or ocular surgeries in the past. The visual acuity was 0.0 Logmar in both eyes. Ocular examination revealed upper and lower tarsal papillae, perilimbal pigmentation, Horner–Trantas spots, and pseudogerontoxon—with a firm, vascularized, well-defined limbal nodule (6 × 4 mm) Fig. 1a, b at the 7–8 o’clock position, features suggestive of VKC.Figure 1: (a) Clinical photograph showing the conjunctival cyst at temporal limbus and (b) upper tarsal papillaeAnterior segment optical coherence tomography (AS-OCT) demonstrated a hyporeflective cystic lesion Fig. 2 in the subconjunctival space with a smooth, hyperreflective epithelial wall, suggestive of a conjunctival inclusion cyst Fig. 3.Figure 2: Horizontal section of anterior segment optical coherence tomography showing hyperreflective epithelial wall and hyporeflective innerspace suggestive of conjunctival cystFigure 3: Vertical section anterior segment optical coherence tomography of the conjunctival cystThe patient was initially observed for 2 months; however, with the onset of foreign body sensation attributable to the cyst, an excision biopsy was performed under local anesthesia. Histopathological examination of the excised specimen revealed features suggestive of angiolymphoid hyperplasia with eosinophilia. Discussion Conjunctival inclusion cysts associated with chronic VKC are uncommon. Chronic inflammation and repeated mechanical friction from giant papillae are believed to contribute to epithelial implantation and cyst formation.1 In circumstances where the size is large or there is foreign-body sensation or corneal astigmatism, cryotherapy or YAG laser or surgical removal may be considered.2,3 Unlike previously reported cases that focused on chronic adult VKC or treatment modalities, our case uniquely documents a pediatric VKC-associated conjunctival inclusion cyst characterized by AS-OCT imaging. This underscores that cyst formation can occur even in younger patients with moderate disease duration, not just in long-standing or severe cases. Authors' contributions Concept (DA), design (DA), data acquisition (AA, PP), edit (PP), Review (DA). Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.