Endoscopic Resection of a Rare Inverted Papilloma Involving the Lacrimal Duct and Sac

Early lacrimal sac neoplasms are often misdiagnosed as lacrimal duct obstruction, delaying appropriate treatment, accelerating tumor progression, and worsening prognosis. By systematically reviewing and summarizing these characteristics, we aimed to assist ophthalmologists and otolaryngologists in accurately diagnosing and managing early-stage lacrimal sac neoplasms. In this retrospective study, patients presenting with epiphora were diagnosed with either lacrimal sac neoplasms or mucoceles. Diagnostic assessments included computed tomography (CT), enhanced magnetic resonance imaging (MRI), and pathological analysis. The study comprised 9 patients (2 male, 7 female) with lacrimal sac neoplasms; 44% had malignancies, and the remaining 56% exhibited benign conditions. There was no statistically significant difference in mean tumor volume or margin characteristics between patients with neoplasms and those with mucoceles. There was no statistically significant difference in the mean width of the nasolacrimal canal between patients with neoplasms (6.49±3.68 mm) and mucoceles (5.50±1.88 mm) (P=0.44). However, the depth of the nasolacrimal canal was significantly greater in the neoplasm group (5.08±3.21 mm) compared to the mucocele group (2.85±0.96 mm) (P=0.042). Notably, lacrimal sac mass extended above the medial canthal tendon in 8 neoplasm patients, unlike any in the mucocele group, demonstrating distinct pathological presentations. Additionally, the diseased eyes in the neoplasm group showed significantly greater nasolacrimal canal width and depth compared to the contralateral eyes (all P<0.05), whereas the mucocele group showed only slightly increased nasolacrimal canal width compared with the contralateral eyes. The findings suggest that patients with a lacrimal sac mass extending above the medial canthal tendon and a nasolacrimal canal deeper than the contralateral side should undergo contrast-enhanced MRI for accurate diagnosis and treatment planning.

In Vitro Study of Microbial Growth in Artificial Tears Using a Novel Kinetic and Culture-Based Model.

Critical factors for successful outcomes of endoscopic dacryocystrhinostomy.

Purpose: To provide an updated focused review of lacrimal sac lymphomas, highlighting epidemiology, clinical presentation, diagnostic workup, histopathological subtypes, management strategies, and outcomes, supplemented by institutional experience. Methods: Narrative literature review of lacrimal sac lymphomas with contextual reference to cases identified at a tertiary eye hospital. Results: Lacrimal sac lymphomas are rare lesions of the lacrimal drainage system, most commonly diffuse large B-cell lymphoma (DLBCL) and mucosaassociated lymphoid tissue (MALT) lymphoma. Presentation frequently mimics primary acquired nasolacrimal duct obstruction, leading to diagnostic delay. Cross-sectional imaging may show a solid lacrimal sac mass with possible extension to adjacent structures. Radiotherapy is commonly used for localized disease, while systemic therapy is employed for high-grade histologies or disseminated involvement. Conclusions: Lacrimal sac lymphomas require a high index of suspicion in atypical, recurrent, or unilateral lacrimal outflow obstruction. Timely biopsy with appropriate immunophenotyping and multidisciplinary care are essential for optimal outcomes.

Infected epidermoid cysts in the medial canthus can clinically mimic acute dacryocystitis, posing diagnostic challenges. The authors report the case of a 13-year-old male with a 2-month history of recurrent right medial canthal redness, swelling, pain, and purulent discharge. Initially misdiagnosed with acute dacryocystitis at another institution, he experienced symptom recurrence despite multiple incisions and drainage attempts. A comprehensive evaluation in our department, including history, physical exam, computed tomography dacryocystography, ultrasonography, and lacrimal endoscopy, was performed. The definitive diagnosis of an infected medial canthal epidermoid cyst was established histopathologically, followed by successful surgical management. This case underscores the principle that infection in the lacrimal sac region is not synonymous with dacryocystitis, emphasizing the necessity of a thorough, multidimensional diagnostic approach to prevent misdiagnosis and ensure timely, appropriate treatment.

ABSTRACT Purpose To report the presentation, management and outcomes of atypical cases presenting with granulomatous diseases of the lacrimal drainage system. Methods Retrospective analysis of biopsy-proven cases presenting with atypical lacrimal drainage system granulomatous diseases over a study period of 2 years (August 2023 to September 2025) was performed. Demographics, clinical presentations, radiological features (CT-DCG), treatment, histopathology, immunohistochemistry, final diagnosis, and outcomes were analysed. Results During the study period, five such cases were found in the database with the average age of patients being 62.4 years (range: 43–70 years). The diagnosis of the atypical lacrimal sac granulomatous diseases includes xanthogranuloma, sclerosing, and non-sclerosing variants of non-specific orbital inflammatory disease, and fungal granulomas. Conclusions Atypical presentations of lacrimal sac granulomatous lesions are an uncommon occurrence and sparsely reported in the literature. They can be differentiated from malignancy based on clinical presentations, a high index of suspicion, and a confirmatory histopathological examination.

To assess the success rate of lacrimal sac hydrostatic pressure application (HPA) maneuver, a conservative office procedure for treatment of congenital nasolacrimal duct obstruction (CNLDO). The medical records of pediatric patients, 36mo old or younger, diagnosed with CNLDO between the years 2016-2022, were retrospectively reviewed. In all children, HPA was performed by a pediatric ophthalmologist. Success was defined as the resolution of epiphora and discharge within 48h of the intervention. A total of 281 eyes (194 patients) with CNLDO underwent HPA. Follow-up data were available for 261 eyes (179 patients, 50.3% male) and these patients were included in the analysis. The mean follow-up time was 11.6±13mo. Ninety-seven patients (54.2%) had unilateral nasolacrimal duct obstruction, while 82 patients (45.8%) had bilateral CNLDO. The mean age at the time of HPA was 5.8±5.9mo. Complete resolution of symptoms was achieved in 102 (39.1%) eyes. Patients 6mo old or younger at the time of HPA had a significantly higher success rate compared to patients older than 6mo (43.7% vs 30.9%, P=0.04). Younger age at the time of pressure application was associated with a higher resolution rate of CNLDO (OR 0.93, P=0.004). Sex assigned at birth, prematurity, laterality of the obstruction and type of symptoms (epiphora, discharge) were not correlated with success. A second HPA was performed in 46 eyes, with resolution of symptoms in 12 eyes (26.1%). Hydrostatic pressure applied on the lacrimal sac by an experienced ophthalmologist or an experienced pediatrician may be an effective treatment for CNLDO. We recommend HPA as an initial active conservative approach in all pediatric patients with CNLDO, especially those younger than 6mo.

Objective: To investigate the clinical, pathological and molecular genetic characteristics of conjunctival melanoma (CoM). Methods: A retrospective case series study was conducted. The clinical, imaging and pathological data of patients diagnosed with CoM from January 2004 to June 2025 at Shaanxi Eye Hospital of Xi'an People's Hospital (Xi'an Fourth Hospital) and Xi'an First Hospital were analyzed. Some patients were detected for the BRAF V600E mutation. The χ2 test or the χ2 correction test was used for statistical analysis. Results: A total of 70 patients (70 eyes) with CoM were enrolled, aged (60.8±10.6) years, including 40 males (57.1%) and 30 females (42.9%). There were 33 cases (47.1%) in the left eye and 37 cases (52.9%) in the right eye. The tumor was located at the bulbar conjunctiva in 37 cases (52.9%), at the vault conjunctiva in 24 cases (34.2%), and at the palpebral conjunctiva in 9 cases (12.9%), involving the orbit in 13 cases (18.6%), the eyeball in 3 cases (4.3%), and the lacrimal sac in 6 cases (8.6%). Most patients presented with black nodules or cauliflower-like masses in the conjunctival area. Some tumors were accompanied by superficial vascular hyperplasia and pigmentation of adjacent tissues, while some invaded the cornea or orbit, resulting in clinical manifestations such as visual field defects, exophthalmos and limited movement. Imaging showed irregular soft tissue density shadows at the conjunctival site. According to the criteria of the American Joint Committee on Cancer, the tumor was at the T1 stage in 10 cases (14.3%), T2 stage in 41 cases (58.6%), and T3 stage in 19 cases (27.1%), with superficial ulcers in 6 cases (8.6%). Histopathology results disclosed that 67 cases (95.7%) were of the nodular type, 3 cases (4.3%) were of the superficially diffuse type, 47 cases (67.1%) were of the epithelial cell type, and 23 cases (32.9%) were of the mixed cell type. Sixty-three cases (90.0%) were accompanied by melanin, 32 cases (45.7%) were accompanied by primary acquired melanosis, including 23 cases (32.9%) with atypical primary acquired melanosis and 2 cases (2.9%) with conjunctival nevus, and 48 cases (68.6%) had tumor infiltrating lymphocytes. Immunohistochemistry demonstrated positive melanin markers such as human melanoma-associated antigen 45, melanocyte antigen A, S-100 protein and sex-determining region Y-frame protein 10. Thirty cases (42.9%) completed the detection of BRAF V600E mutations, of which 11 had BRAF V600E point mutations, with a positive rate of 36.7%. Sixty-two patients (88.6%) were followed up, with a recurrence rate of 27.4% (17/62), a metastasis rate of 19.4% (12/62), and a case fatality rate of 54.8% (34/62). The recurrence rate was 4/5 among patients with ulcers, versus 22.8% (13/57) among patients without ulcers (χ2=4.96, P=0.026); it was 8/13 among patients with orbital invasion, versus 18.3% (9/49) among patients without orbital invasion (χ2=9.62, P=0.002). Thirty-four patients (48.5%) underwent complete resection of the ocular mass, 16 (22.9%) underwent partial resection, and 20 (28.6%) underwent ocular or intraorbital enucleation. Ten patients (14.3%) received BRAF inhibitor-targeted therapy. Seven patients had a significant reduction of the residual mass and no tumor progression, and 3 patients did not respond to the treatment and died from the disease progression. Conclusions: CoM mostly occurs in the unilateral eye of middle-aged and elderly patients, more common at the bulbar conjunctiva and fornix conjunctiva, and histopathological epithelial cell types are the main types, with a high recurrence and metastasis rate.

PurposeTo describe the clinical features, intraoperative findings, and management outcomes of children with congenital nasolacrimal duct obstruction (CNLDO) complicated by atonic lacrimal sac.MethodsA retrospective review was conducted on children diagnosed with CNLDO and intraoperatively confirmed atonic lacrimal sac between January 2017 and December 2023 at two tertiary centers. Data included demographics, clinical findings, type of obstruction, intervention, and outcomes. Success was defined as normal fluorescein dye disappearance with absence of epiphora or discharge.ResultsSixty-eight eyes of 65 children (median age, 3.5 years; range, 6 months-12 years; 60.3% males) were analyzed. Membranous obstruction was identified in 82.4% and firm obstruction in 16.2% of eyes. Probing alone was performed in 55 eyes (80.9%), while probing with additional intraoperative procedures were performed in 13 (19.1%), including silicone intubation in 11 and balloon dacryoplasty in 2. Success after the primary procedure was 67.6% at a mean follow-up of 9.9 ± 14.9 months. Younger age and membranous obstruction correlated with higher success. The additional procedures with probing did not have a significant impact on successful outcomes. Of 22 failures, 13 underwent secondary Dacryocystorhinostomy (DCR), all achieving complete anatomical and functional resolution.ConclusionsAtonic lacrimal sac represents an uncommon subtype of complex CNLDO. Most cases respond favorably to standalone probing combined with prolonged lacrimal sac compressions, particularly in younger children with membranous obstruction. DCR remains an effective second-line treatment for refractory cases.

Background: Primary malignant melanoma of the lacrimal sac is a sporadic and aggressive tumor, accounting for less than 1% of all lacrimal sac neoplasms.Because its symptoms-such as persistent epiphora, medial canthal swelling or bloody dischargeclosely resemble chronic dacryocystitis, diagnosis is often delayed until the disease has reached an advanced stage.Radiological imaging, particularly MRI and CT, plays a pivotal role in early detection, while definitive diagnosis relies on histopathology and immunohistochemistry. Recent advances in immunotherapy have expanded therapeutic options for mucosal melanomas in anatomically complex sites such as the lacrimal drainage system.Case presentation: A 60-year-old man presented with progressive tearing and swelling at the left medial canthus, accompanied by intermittent blood-stained discharge for three months.Physical examination revealed a firm, non-mobile mass over the lacrimal sac without cutaneous ulceration.CT and MRI demonstrated a well-defined lesion within the left nasolacrimal canal, showing T1 hyperintensity and T2 hypointensity suggestive of a pigmented neoplasm.Histopathological examination confirmed malignant melanoma with immunopositivity for HMB-45, Melan-A and S-100.PET-CT revealed distant metastases at diagnosis.The patient received systemic immunotherapy with pembrolizumab (200 mg every three weeks), achieving partial remission before progression at 18 months.He was subsequently placed on palliative care.Discussion: This case underscores the diagnostic challenges of lacrimal sac melanoma, given its rarity and nonspecific presentation.Multimodal imaging and early biopsy are crucial to distinguish it from chronic inflammatory disease.Immunotherapy, particularly PD-1 blockade, represents a promising alternative to extensive surgery in metastatic or unresectable cases. Conclusion:Prompt recognition and multidisciplinary management are essential for improving outcomes in this aggressive malignancy.Lifelong surveillance remains mandatory due to the high risk of recurrence and metastasis.

Spontaneous passage of dacryoliths has been described, but it remains an exceptional event. A 40-year-old female with lacrimal sac dilatation and a suspected partial nasolacrimal duct obstruction on irrigation was advised 3D cone-beam computed tomography-dacryocystography. The contrast agent used was a viscoelastic barium sulfate. Initial immediate image evaluation revealed a distinct and sharp intraluminal filling defect at the junction of the lacrimal sac and nasolacrimal duct with an interrupted contrast column, suggestive of a dacryolith (Panel 1, A–C). Since the dense contrast further distended the lacrimal sac swelling, a compression was applied to empty the sac through regurgitation. The examiner felt a sudden release, and the patient immediately reported passage of material into the nasal cavity. Endoscopic examination showed contrast material in the nasal cavity. To confirm the suspected expulsion, a repeat 3D cone-beam computed tomography-dacryocystography was performed approximately 20 minutes later, which demonstrated the absence of any filling defect, patent lacrimal sac and nasolacrimal duct, and an uninterrupted contrast column (Panel 2, A–C). Subsequent lacrimal irrigation was patent. At the 6-month follow-up, the patient was asymptomatic. The use of a dense, viscoelastic contrast agent, combined with the lacrimal sac compression, may have facilitated the mechanical propulsion of the dacryolith. This case highlights the dual diagnostic and therapeutic potential of modern 3D dacryocystography in select cases of partial nasolacrimal duct obstruction.FIG.:

We present an SWItch/Sucrose NonFermentable (SWI/SNF) complex-deficient carcinoma centered in the lacrimal drainage system and orbit of a 76-year-old male. The patient presented with nasolacrimal duct obstruction, which persisted after dacryocystorhinostomy. Imaging and surgical exploration showed a 3-cm orbital mass centered around the lacrimal sac with involvement of the nasolacrimal duct and orbit. Microscopic examination revealed sheets, nests, and strands of poorly differentiated tumor cells. Some had enlarged hyperchromatic nuclei and eosinophilic cytoplasm, and others had round to oval, somewhat vesicular nuclei with paler cytoplasm. In situ carcinoma was present in the lacrimal sac lining, with invasion into adjacent structures. Immunohistochemical analysis showed loss of INI1 protein in the neoplastic cells, with retained expression in non-neoplastic stroma. While a few SWI/SNF complex-deficient sinonasal carcinomas have been shown to invade into the orbit, this case highlights the need to consider this rare entity in the differential diagnosis of tumors arising in the lacrimal drainage system.

Purpose This study primarily aimed to identify the causes of failed dacryocystorhinostomy (DCR) with high ostium and analyze the associated radiological and endoscopic findings. Methods A retrospective interventional case series was conducted to analyze 72 eyes (from 69 patients) with high ostia and failed DCRs, all revised by the same surgeon between January 2015 and December 2024. The data collected included patient demographics, diagnostic and management details, objective measurements of computerized tomography dacryocystography (CT-DCG) images, and endoscopic findings. CT-DCG and endoscopy findings from 33 successful primary DCR cases were used as controls. Results The most common reasons for primary DCR failure were cicatricial closure of the DCR ostium (97.2%, 70/72), and creation of a small or inappropriately positioned bony ostium. Early recurrence (at one-month post-operatively) occurred in 62.5% (45/72) of cases. Compared with the successful group, the failed group had more prior laser DCR interventions and intubations before the primary DCR surgery (p = 0.03). The failed group also had a higher incidence of associated sinusitis (p = 0.011). The distance from the superior boundary of the ostium to the frontomaxillary suture on CT-DCG was significantly variable between the cases and the controls (p = 0.003). The CT-DCG findings of inadequate bone removal overlying the lacrimal sac, the unaddressed anterior uncinate process, ostium location away from the middle turbinate axilla, and the unopened agger nasi cell appeared to be the factors that influenced the outcomes of the initial DCR (p < 0.05). At the last follow-up, the anatomical success following revision of the prior high ostium failed DCRs was achieved in 95.8% (69/72), and the outcomes were excellent. Conclusion This study provides a precise CT-DCG and endoscopic comparison between high ostium failed DCRs and the ostia of successful cases. Analysis and objective measurements of CT-DCG provided valuable insights during the revision surgery in such cohorts.

Congenital dacryocystocele (CD) represents a rare yet clinically significant subtype of congenital nasolacrimal duct obstruction. It carries a substantial risk of severe secondary infection, yet its risk factors have not been fully elucidated. This study aimed to identify the independent risk factors for secondary infection in infants with CD and to evaluate the impact of infection on treatment course and prognosis. A retrospective cohort study was conducted in 100 infants (118 eyes) diagnosed and treated for CD in a tertiary hospital between January 2017 and December 2024. Demographic characteristics, clinical features, and treatment details were collected and analyzed. Univariate analysis and a multivariate logistic regression model were used to identify independent risk factors associated with secondary infection. Secondary infection occurred in 60 of the 118 eyes (50.85%, 95% confidence interval (CI): 41.50-60.20%). Multivariate logistic regression analysis identified three independent risk factors for secondary infection: concomitant intranasal cyst (adjusted odds ratio (aOR) = 5.07, 95% CI: 2.10-12.23, p < 0.001), a history of lacrimal sac massage (aOR = 3.11, 95% CI: 1.29-7.46, p = 0.01), and disease onset during the winter-spring season (aOR = 2.97, 95% CI: 1.27-6.93, p = 0.01). Compared to the non-infected group, infants with secondary infection required a significantly longer treatment duration (median: 6.00days vs.1.00day, p < 0.001) and required more invasive management. Concomitant intranasal cyst, a history of lacrimal sac massage, and winter-spring season onset are strong independent predictors of secondary infection in CD. Secondary infection is associated with not only a prolonged treatment course but also a higher probability of invasive intervention. These findings highlight the need for accurate diagnosis and adherence to standardized treatment protocols in infants with CD.

To evaluate anatomical and structural parameters of the lacrimal sac and nasolacrimal duct system measured through dacryocystography with computed tomography (Dacryo-CT) in relation to restenosis after endoscopic dacryocystorhinostomy (DCR) in a cohort of patients. This retrospective study included patients undergoing endoscopic DCR with preoperative Dacryo-CT imaging. Parameters analyzed included the dimensions of the lacrimal sac (vertical and horizontal axes), the thickness of the bone anterior to the lacrimal sac, the thickness of the sac walls, the ratio of nasolacrimal duct length to the extent of contrast medium descent, and the ratio of sac width to wall thickness. Restenosis was defined clinically and confirmed endoscopically within 18 months postoperatively. Multivariate logistic regression was performed to assess the association between Dacryo-CT parameters and restenosis. Of 100 patients, restenosis occurred in 28 (28%). Restenosis was significantly associated with a reduced vertical axis of the lacrimal sac (mean, 7.8 vs. 10.2 mm, p < 0.01) and increased sac wall thickness (mean, 1.5 vs. 1.2 mm, p = 0.02). A higher ratio of sac width to wall thickness correlated with a lower restenosis rate (p = 0.04). The thickness of the anterior bone and the nasolacrimal duct length/contrast descent ratio showed no significant correlation with restenosis risk. Preoperative Dacryo-CT-derived parameters, particularly lacrimal sac dimensions and wall thickness, may predict restenosis risk after endoscopic DCR. These findings highlight the importance of detailed anatomical evaluation to optimize surgical outcomes.

Lacrimal sac squamous cell carcinoma (LSSCC) is the most common tumor of the rare disease subsite of the nasolacrimal system. Circulating tumor DNA (ctDNA) has emerged as a biomarker for non-invasive monitoring of tumor burden and treatment response across a variety of solid tumors. In this case study, we report ontwo patients with histologically confirmed HPV + (HPV16 and HPV33) LSSCC managed with definitive chemoradiotherapy who underwent serial ctDNA monitoring prior to, during, and following treatment using an ultrasensitive multi-feature HPV whole genome sequencing liquid biopsy. In this case study, we report ontwo patients with histologically confirmed HPV + (HPV16 and HPV33) LSSCC managed with definitive chemoradiotherapy who underwent serial ctDNA monitoring prior to, during, and following treatment using an ultrasensitive multi-feature HPV whole genome sequencing liquid biopsy. This report suggests that ctDNA monitoring is a feasible approach for detection and monitoring of HPV + LSSCC. We advocate for continued p16 immunohistochemistry in all squamous cell carcinomas arising in the lacrimal sac. Confirmation with HPV ISH or PCR should be performed given the potential impact on management and surveillance.

Lacrimal sac malignancies are rare, with squamous cell carcinoma (SCC) being the most common type. High-risk human papillomavirus (HR-HPV) is a known driver of SCC in the oropharynx and other head and neck sites. This study investigated the prevalence of HR-HPV in primary lacrimal sac SCC using p16 immunohistochemistry and RNA in situ hybridization. The pathology databases of the Florida Lions Eye Bank Ocular Pathology Laboratory and the Department of Pathology and Laboratory Medicine at the University of Miami Miller School of Medicine were reviewed for cases of primary lacrimal sac SCC with sufficient tissue for HR-HPV testing. P16 positivity was defined as strong, diffuse staining in >70% of tumor cells. RNA in situ hybridization was used to detect transcriptionally active HR-HPV. Fifteen patients (mean age 63 years; 7 men and 8 women) with nonkeratinizing, papillary lacrimal sac SCC were identified. Twelve cases (80%) were positive for both p16 and HR-HPV by RNA in situ hybridization. All 3 HR-HPV negative cases were also p16-negative. Among HR-HPV-positive patients, 92% were Caucasian, with equal gender distribution. The most common presenting symptoms were epiphora (83%), erythema/edema (42%), and pruritus (33%). Most patients were treated with surgery and multimodal therapy. At follow-up (range 5-83 months), 92% of HR-HPV-positive patients were alive. Primary lacrimal sac SCCs are frequently associated with HR-HPV and typically show nonkeratinizing, papillary morphology. p16 is a reliable surrogate marker for transcriptionally active HR-HPV in these tumors, supporting a potential etiologic role and diagnostic utility.

Chronic dacryocystitis is the most common disorder of the lacrimal drainage system, resulting from a long-standing obstruction of the nasolacrimal duct that leads to tear stagnation, secondary infection, and chronic inflammation of the lacrimal sac. It commonly presents with insidious epiphora, painless medial canthal swelling, and mucoid or purulent regurgitation, progressing through catarrhal, mucocele, suppurative, and fibrotic stages, with potential complications such as corneal ulceration, lacrimal abscess, fistula, and orbital cellulitis. This case reports a 56-year-old diabetic male with chronic right-sided epiphora and lacrimal sac swelling of four months’ duration, with positive regurgitation test and Munk score grade 1. While conventional management includes syringing, probing, and dacryocystorhinostomy, the condition in Ayurveda is correlated with Pooyalasa, a Sannipātika sandhigata roga of the Kaninaka sandhi, described as a two-stage pathology progressing from swelling to Vrana and potentially Pilla roga if left untreated. An integrative Ayurvedic approach using internal medications such as Patoladi Kashaya for Kleda-meda Visoshana, Shothahara, and Ropana effects; Triphala Guggulu for Shothaprasamana, Krimighna, Rasayana, and tissue-healing actions; and Guggulu Panchapala Churna for Srotoshodhana, Lekhana, and Vranashodhana was employed, along with local therapy using Ilaneer Kuzhambu Anjana for effective debris clearance and ocular tissue preservation, and Tulasi arka with Saindhava for enhanced antibacterial, anti-inflammatory action and deeper drug penetration. This highlights the relevance of Ayurvedic management in chronic dacryocystitis for reducing inflammation, preventing recurrence, and offering a non-surgical, holistic therapeutic alternative.

AimThis study aimed to characterize the clinical presentation, pathological features, and prognostic indicators of ocular mucoepidermoid carcinoma (MEC) based on an institutional cohort and a systematic literature review.MethodsA retrospective analysis was conducted including two distinct datasets: six patients with histopathologically confirmed ocular MEC treated at our institution and twenty-one cases identified through literature review. Institutional cases were evaluated for clinical course, treatment, and recurrence, whereas literature-derived cases were summarized descriptively due to reporting heterogeneity and incomplete follow-up.ResultsPatients in the institutional cohort (n = 6) had a median age of 64 years, with no sex predominance. The lacrimal gland was the most frequent primary site, followed by the eyelid and lacrimal sac. The predominant manifestation was a painless orbital mass, while diplopia and visual loss were less frequent. Intermediate-grade lesions were most common, and orbital tissue invasion was histologically confirmed in two patients. Both patients with invasion experienced tumor recurrence, whereas no recurrence was observed among patients without invasion during follow-u No disease-related deaths occurred within this cohort. The literature-derived group demonstrated substantial variability in grading, invasion patterns, and follow-up duration, reflecting selective reporting toward advanced or recurrent cases.ConclusionsOcular MEC demonstrates a high tendency toward local recurrence but generally low disease-specific mortality. Orbital tissue invasion appears to be associated with an elevated risk of recurrence in the institutional cohort, underscoring the need for prolonged surveillance. Given the marked heterogeneity of published cases, survival inference should be limited to consistently followed institutional data.