Treatment of Conjunctival Inclusion Cysts
Symptomatic conjunctival inclusion cysts should be mechanically removed at the slit lamp using a sterile 25-30 gauge needle or fine forceps under topical anesthesia, followed by topical antibiotic prophylaxis for 3-5 days. 1
Indications for Treatment
Treatment is warranted when cysts cause:
- Corneal epithelial defects from protruding cysts 1
- Visual disturbance 1
- Moderate to severe pain 1
- Foreign body sensation or ocular irritation 2, 3
Asymptomatic cysts may be observed, as some resolve spontaneously 4
Office-Based Removal Procedure
Preparation and Technique
- Apply topical anesthesia (e.g., proparacaine 0.5%) at the slit lamp 5
- Evert the eyelid completely to visualize all cysts on the superior or inferior tarsal conjunctiva 1, 5
- Use a 25-30 gauge needle or jeweler's forceps to puncture and extract the cyst contents 1, 5
- Perform bimanual drainage if purulent material is present 2
Critical Pitfall to Avoid
- Never perform blind sweeping of the fornices, as this causes unnecessary conjunctival damage 1
Post-Procedure Management
Immediate Care
- Prescribe topical antibiotic drops (moxifloxacin, tobramycin, or polymyxin B/trimethoprim) 3-4 times daily for 3-5 days to prevent secondary infection 1, 5, 2
- Consider brief topical corticosteroid use (e.g., loteprednol 0.5%) if significant conjunctival inflammation is present, with intraocular pressure monitoring 1, 5
Addressing Underlying Causes
- Prescribe preservative-free artificial tears to treat underlying dry eye disease that contributes to cyst formation 1, 5
- Treat chronic blepharitis with lid hygiene and topical antibiotics if present 1, 5
- Discontinue offending topical medications (particularly preserved glaucoma drops) that cause chronic conjunctival inflammation 5
Follow-Up Protocol
- Schedule follow-up in 3-7 days to assess healing and ensure no residual cysts remain 1, 5
- Perform slit-lamp biomicroscopy to evaluate for corneal epithelial defects or persistent inflammation 5
Alternative Treatment Options
For post-surgical cysts (particularly after strabismus surgery):
- Thermal cautery under slit-lamp visualization is a fast, effective, and well-tolerated alternative 4
- Isopropyl alcohol injection using paired injection technique has shown no recurrence at 9 months follow-up 6
- Complete surgical excision may be necessary for large or recurrent cysts 3, 7
When to Refer to Ophthalmology Immediately
Refer for: