Treatment of conjunctival cysts in anophthalmic socket with intralesional injection of trichloroacetic acid ( ATA ) 25 % Tratamento de cistos conjuntivais em cavidade anoftálmica com injeção intralesional de ácido tricloroacético ( ATA ) a 25 %

1Ophthalmologist, Fellow at the Oculoplastic Surgery Unit, Department of Clinical Ophthalmology, University Hospital of the São Paulo University (USP), São Paulo/SP, Brazil. 2Ophthalmologist and Supervisor at the Department of Clinical Ophthalmology, University Hospital of the São Paulo University (USP), São Paulo/ SP, Brazil. 3Associate Professor and Head of the Oculoplastic Surgery Unit, Department of Clinical Ophthalmology, University Hospital of the São Paulo University (USP), São Paulo/SP, Brazil.


C
onjunctival cysts are complications occurring in anophthalmic sockets which may cause local discomfort and difficulty fitting an ocular prosthesis on the anterior surface of the socket.
This article reports on the use of 25% TCA in three cases of conjunctival cysts.

METHODS
Patients were placed in the supine position.One eye drop of 0.5% proxymethacaine was instilled 5 minutes and immediately before the procedure.After antisepsis, asepsis and placement of a blepharostat, the cyst was punctured with a 31×4 mm needle connected to a 3 ml syringe containing 1 ml of 25% TCA aqueous solution.The aspirated contents were then reinjected until the cyst acquired a whitish appearance.The contents were then reaspirated until the cyst walls collapsed.
Patients were then prescribed 0.3% ofloxacin and 1% prednisolone eye drops, one drop every 6 hours for 7 days.They were reassessed 7 days and 30 days after the procedure.

Case reports
Case 1.A 54-year-old male underwent evisceration of the left eye after having his eye pierced 2 years ago.He was referred to the Oculoplastic Surgery Unit of the University Hospital of the São Paulo University (HCFMUSP) with a conjunctival lesion that had been gradually increasing for 3 months and caused him to have difficulty using an ocular prosthesis.
The patient received a 1 ml intralesional injection of 25% TCA (Figure 1), but did not return for follow-up.
Case 2. A 56-year-old female underwent two tectonic corneal grafts in the left eye, the most recent 1 year ago.The case progressed to phthisis bulbi.She was referred to the Oculoplastic Surgery Unit of HCFMUSP with a conjunctival lesion that had been gradually increasing for 6 months.She reported discomfort on blinking.
The patient received a 1 ml intralesional injection of 25% TCA.She returned for follow-up 1 month after the procedure with no complaints (Figure 2).Case 3. A 78-year-old female patient underwent evisceration of the left eye three years ago due to postoperative endophthalmitis.She was referred to the Oculoplastic Surgery Unit of HCFMUSP with a conjunctival lesion that had been gradually increasing for 9 months, causing discomfort while using an ocular prosthesis.
The patient received a 1 ml intralesional injection of 25% TCA.She returned for follow-up 1 month after the procedure with no complaints (Figure 3).

DISCUSSION
The procedure was well tolerated by all patients, who reported mild discomfort during the injection of 25% TCA.There were no complications during the study period, with adequate conjunctival regeneration and no relapse in the 2 patients who returned for follow-up.
The treatment of conjunctival cysts in anophthalmic sockets is required when it interferes with an ocular prosthesis, causes discomfort or has cosmetic implications for the patient.
Of the therapeutic options, the most common are excision and marsupialisation (1) .However, these require a new surgical procedure, and complete resection of the cyst may be difficult, thus increasing the risk of relapse.
Hornblass et al. (2) described a series of 4 cases treated with intralesional injection of absolute alcohol.Resolution was observed in 2 cases, but the follow-up time was not reported The

Figure 2 :Figure 3 :Figure 1 :
Figure 2: Clockwise, starting from the top left image: Appearance before, immediately after, 7 days after, and 30 days after the injection of 25% TCA