Caruncular dacryops with extruded secretory globoid bodies

A 52-year-old black man evaluated for a left cataract following an iritis was incidentally noted to have a vascularized, firm, inflammatory-appearing left caruncular mass. Removal of the cataract and of the left caruncular mass led to the discovery that the latter was composed of dilated channels containing secretory globoid bodies; the cyst wall was composed of a double layer of cuboidal epithelium, occasionally displaying apical cytoplasmic snouts. Lobules of lacrimal gland tissue were found in intimate association with the cystic spaces in multiple foci. The secretory globoid bodies had ruptured from the cystic cavity into the connective tissue of the caruncle, where a multinucleated foreign body-type granulomatous response had been elicited. This spontaneous rupture and the ensuing inflammation accounted for the inflammatory character of the lesion on clinical examination. The authors believe that secretory globoid bodies are a distinctive feature of dacryops, which normally occurs in the major lacrimal gland. When dacryops occurs in a minor lacrimal gland of the caruncle or fornices (glands of Krause or Wolfring), the presence of secretory globoid bodies may help to distinguish dacryops in these unusual locations from small conjunctival inclusion cysts, which sometimes have calcareous inclusions but lack the myriad spherical secretory bodies of dacryops.