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Page 4 of 5 Fung et al. Plast Aesthet Res 2020;7:55 I http://dx.doi.org/10.20517/2347-9264.2020.60

typically show a T2 hyperintense, T1 hypointense mass with enhancement of the wall after gadolinium
consistent with a fluid filled cyst [8,24] . Histopathology of WD typically reveals a non-keratinizing, double
layer of cuboidal to columnar epithelium [9,11,12,21] . Given the location of the cyst at the superior tarsal border,
the cyst could potentially stretch or cause a dehiscence of the Muller’s muscle underneath, which is a
[25]
potential alternative mechanism for the ptosis .

Complete surgical excision of the intact cysts is recommended for symptomatic lesions (large lesions,
lesions that induce significant refractive error, symptomatic ptosis, disfigurement, or are potentially
amblyogenic) [11,13,26] , but our patient’s upper eyelid WD was asymptomatic, and his mild ptosis was
not amblyogenic. However, ptosis in children can often cause amblyopia, and, as such, a referral to
an ophthalmologist may be warranted. Dacryops is a benign entity, but complicated cases involving
[9]
fistulization of the cyst, hemorrhage, and superimposed infection have been reported . After a discussion
of options, the patient and his family decided to monitor the lesion with serial eye exams.

This report describes a rare cause of mechanical ptosis in a child and illustrates the importance of a
thorough eye exam in cases of acquired ptosis in childhood.

DECLARATIONS
Acknowledgments
The authors thank Research to Prevent Blindness (RPB) for their support of the UC San Diego Shiley Eye
Center.

Authors’ contributions
Made substantial contributions to the conception and design of this case, contributed to the drafting and
editing of the manuscript, and approved the final version to be published: Fung SE, Liu CY
Made substantial contributions to the drafting and editing of the manuscript, and approved the final
version to be published: Men CJ, Korn BS, Kikkawa DO

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflict of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
The case report adheres to the ethical principles outlined in the Declaration of Helsinki and is HIPAA
compliant. The patient consented to participation of the clinic visit and consultation in accordance with the
institution policy.

Consent for publication
Consent was obtained from the patient for publication of images and details of the clinical case discussed.

Copyright
© The Author(s) 2020.