Infiltrating ocular dermolipoma leading to diplopia

Abstract

We report the observation of a 12-year-old child, who had left lower temporal swelling, gradually increasing in volume, evolving over several years, causing discomfort to ocular motility with binocular diplopia in the abduction look. The visual acuity was at 60/60 in both eyes, the anterior and posterior segment were without particularities. The examination found a voluminous « yellow» conjunctival swelling in inferior-temporal of left eye, not reaching the limb and whose size is unmodifiable. The eye motility examination found a limitation of abduction of the left eye, confirmed by a Lancaster test. An orbito-cerebral MRI was performed, revealing an orbital tumor of «greasy» density, with a suspicion of muscle infiltration, strongly suggestive of a dermolipoma. The patient had a surgical resection of the tumor, with a good post-operative evolution. The conjunctival dermolipoma is a benign congenital tumor, usually located at the temporal region of the bulbous conjunctiva, near the lateral canthus, its represent 5% of all orbital lesions in children. Dermolipoma are most often asymptomatic, or may progress during the first or second decade of life, and become visible in the primary eye or in adduction, requiring surgery for cosmetic purposes. However, many precautions must be taken, as cases of diplopia, strabismus, blepharoptosis and dry keratocontivitis, were reported after surgery, following aggressive resection; by damaging the right muscles, the upper eyelid lifter and the tear gland. Therefore, resection of the dermolipoma should be treated more conservatively,to avoid this complications..