Surgical excision and distilled water lysis of a congenital corneal intrastromal cyst

PURPOSE: To describe imaging findings and encourage the use of distilled water as an adjuvant osmolytic in the surgical management of corneal intrastromal cysts. OBSERVATIONS: A five-year-old female with no history of ocular trauma presented with a visually significant corneal opacity of the left eye. She was diagnosed with a presumed corneal intrastromal cyst and underwent surgical excision with distilled water osmolysis of the cyst cavity. CONCLUSIONS AND IMPORTANCE: Optical coherence tomography (OCT) can confirm diagnosis of intrastromal cysts. Presumed epithelial cell nests remain visible at post-operative month eight, with no evidence for cyst recurrence. The authors propose that OCT findings are pathognomonic for corneal intrastromal cysts and that cyst excision combined with distilled water osmolysis at the time of debridement may be beneficial in conserving tissue integrity.