Photo Quiz

Conjunctival Lesion in a 10-Year-Old Girl


Am Fam Physician. 2020 Mar 15;101(6):375-376.

A 10-year-old girl presented with a lesion on her eye that appeared one month prior. The lesion was not painful, and she had no changes in her vision. Her medical history was unremarkable, including no eye trauma or injury. She had no history of contact lens use.

Physical examination revealed a smooth, clear, fluid-filled lesion on the lateral aspect of the left eye (Figure 1). The surrounding conjunctiva was erythematous. The physical examination was otherwise normal.




Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Conjunctival bleb.

B. Conjunctival cyst.

C. Pinguecula.

D. Pterygium.

E. Pyogenic granuloma.


The answer is B: conjunctival cyst. Conjunctival cysts are thin-walled inclusion cysts that progress slowly.1 They commonly occur in the lower fornix at the junction of the conjunctival membranes lining the inside of the eyelid and the eyeball.2 The cysts are lined with epithelial cells and often filled with clear fluid, although they may appear to be solid on visualization.3

Conjunctival cysts are typically asymptomatic and may resolve spontaneously, although the probability of spontaneous resolution is unknown. As the cysts grow, they can become symptomatic and may cause disfigurement, discomfort or foreign body sensation, dry eyes, reduced extraocular motility, or difficulty with eye closure.1 Primary cysts are congenital and often remain hidden in the fornix until they increase in size and become symptomatic.1 Secondary cysts are due to trauma, degeneration, or rarely parasitic infections such as cysticercosis.1

Asymptomatic conjunctival cysts do not need treatment and can be

Address correspondence to Matthew Hawks, MD, at Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


1. Thatte S, Jain J, Kinger M, et al. Clinical study of histologically proven conjunctival cysts. Saudi J Ophthalmol. 2015;29(2):109–115.

2. Bell AL, Rodes ME, Collier KL. Childhood eye examination [published correction appears in Am Fam Physician. 2014;89(2):76]. Am Fam Physician. 2013;88(4):241–248. Accessed January 29, 2020.

3. Olivier JF. Common conjunctival lesions. CME. 2013;31(4):134–137.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

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