Conjunctival cysts develop due to several factors. The most common cause is retention of secretions from the conjunctival epithelium, often following minor trauma or inflammation. Surgical procedures like pterygium removal or strabismus surgery can lead to cyst formation during healing. Chronic inflammation from conditions like allergic conjunctivitis creates an environment conducive to cyst development. Foreign bodies or contact lens wear may cause micro-trauma to the conjunctiva, triggering cyst formation. Some cysts are congenital, present from birth due to embryological development anomalies. Certain systemic conditions like ocular rosacea or Stevens-Johnson syndrome increase the risk. Environmental factors including UV exposure, dust, and pollution can contribute to conjunctival irritation and subsequent cyst formation. While most conjunctival cysts are benign, they occasionally result from degenerative changes or, rarely, represent early neoplastic processes, highlighting the importance of proper evaluation by an ophthalmologist.

Several factors determine whether a conjunctival cyst requires removal. Size is a primary consideration—larger cysts that interfere with vision or eyelid closure typically warrant removal. Persistent discomfort, foreign body sensation, or eye irritation that doesn't resolve with conservative measures indicates intervention may be necessary. Cysts that cause cosmetic concerns affecting self-confidence or social interactions are valid reasons for removal. Rapid growth or changes in appearance (color, texture, vascularity) necessitate removal and pathological examination to rule out malignancy. Cysts that repeatedly become infected or inflamed despite treatment should be removed to prevent recurrent episodes. Those that interfere with contact lens wear or proper tear film distribution may require removal to restore normal eye function. Your ophthalmologist will evaluate these factors along with your medical history and preferences to determine the appropriate course of action. Many small, asymptomatic cysts can be safely monitored without intervention.

Conjunctival cyst removal involves minimal pain due to effective anesthesia techniques. Before the procedure, topical anesthetic eye drops are applied to numb the eye surface completely. For larger cysts or more extensive procedures, a small subconjunctival injection of local anesthetic may be administered—this causes brief discomfort lasting only a few seconds. During the procedure itself, you should feel pressure or manipulation but no sharp pain. After the anesthesia wears off (typically 1-2 hours post-procedure), mild discomfort, grittiness, or foreign body sensation is normal and usually manageable with over-the-counter pain relievers like acetaminophen. Prescription pain medication is rarely needed. Most patients describe the recovery discomfort as 2-3 on a 10-point scale. Cold compresses can help reduce any post-procedure discomfort. If you experience severe or increasing pain after the procedure, contact your ophthalmologist immediately as this could indicate a complication requiring prompt attention.

Recovery after conjunctival cyst removal is typically quick and straightforward. Most patients experience mild redness, irritation, and watery discharge for 24-48 hours following the procedure. Vision may be temporarily blurry due to eye drops or ointment but usually clears within hours. You can generally return to desk work or light activities the day after the procedure. Contact lens wear should be avoided for 1-2 weeks as advised by your ophthalmologist. Swimming and activities that might expose your eye to dust or contamination should be postponed for 1-2 weeks. Complete healing of the conjunctival tissue typically occurs within 7-14 days. Follow-up appointments are usually scheduled 1 week after the procedure to ensure proper healing. Most patients can discontinue antibiotic drops after 5-7 days. While the surface heals quickly, internal healing continues for 3-4 weeks, so some mild residual redness may persist during this period. The vast majority of patients experience no long-term effects and return to all normal activities within two weeks.

Recurrence rates for conjunctival cysts depend on several factors. With complete surgical excision where the entire cyst wall (capsule) is removed, recurrence rates are low—approximately 5-10%. Simple needle aspiration (draining the fluid without removing the cyst wall) has a high recurrence rate of 50-80% because the secreting cells remain intact. The location of the cyst affects recurrence risk; fornix cysts (in the pocket where the eyelid meets the eyeball) have higher recurrence rates than those on the bulbar conjunctiva (covering the white of the eye). Underlying conditions like chronic inflammation or allergic conjunctivitis increase recurrence risk if not adequately managed. Surgical technique is crucial—incomplete removal of the cyst wall significantly increases recurrence likelihood. To minimize recurrence risk, your ophthalmologist may recommend complete excision rather than simple drainage, prescribe anti-inflammatory medications post-procedure, advise on managing underlying conditions, and schedule appropriate follow-up to monitor for early signs of recurrence. If recurrence does occur, alternative treatment approaches may be considered for subsequent removal.

Several alternatives to surgical removal exist for managing conjunctival cysts. Observation is appropriate for small, asymptomatic cysts as some resolve spontaneously over time. Warm compresses applied for 5-10 minutes several times daily may help reduce cyst size by promoting drainage. Lubricating eye drops can alleviate discomfort associated with smaller cysts. For inflammation-related cysts, topical anti-inflammatory medications like mild steroid drops (under ophthalmologist supervision) may reduce cyst size. Needle aspiration provides temporary relief by draining fluid but has high recurrence rates. Some ophthalmologists use intralesional steroid injection for certain types of cysts. Newer approaches include YAG laser treatment to create an opening in the cyst wall. However, these alternatives are generally most effective for small, uncomplicated cysts. Larger cysts, those causing significant symptoms, or cysts that have recurred after conservative management typically require surgical excision for definitive treatment. Your ophthalmologist will recommend the most appropriate approach based on the cyst's characteristics, your symptoms, and medical history.