Orbital Dermoid Cyst Research Articles

Dermoid cyst simulating mucocele of lacrimal sac: A case report

A dermoid cyst in the orbit is a choristoma (clump of normal tissue in an atypical location). It results from the migration of ectoderm to a hypodermic location along embryonic lines of closure. Orbital dermoid cysts are usually located superiorly, either temporal or nasal. A dermoid cyst situated close to the lacrimal sac area is extremely rare (Only six published cases to the best of our knowledge). Here, we report a case of a dermoid cyst presenting with swelling over the lacrimal sac area simulating mucocele. The mass was excised by an external dacryocystorhinostomy (DCR) incision approach and the histopathological examination revealed a dermoid cyst. Although rare, the dermoid cyst should also be considered as one of the differential diagnosis in case of swelling in the lacrimal sac area.

Neurosurgical approach in intra-conical orbital dermoid cyst: a case report

Neurosurgical approach in intra-conical orbital dermoid cyst: a case report

Differentiating intradiploic orbital dermoid and epidermoid cysts utilizing clinical features and machine learning.

Purpose:The purpose of this study was to characterize intradiploic dermoid and epidermoid orbital cysts to determine any differences in clinical, radiographic, or surgical features.Methods:A retrospective review was performed of patients presenting with intradiplopic dermoid or epidermoid cysts. Additionally, a complete review of the literature was performed to identify cases of intradiplopic orbital dermoid and epidermoid cysts. Data collected included age, sex, presenting symptoms, location of intradiplopic cyst, ophthalmic findings, treatment, and follow-up. Clinical features of dermoid versus epidermoid cyst were compared. Additionally, machine-learning algorithms were developed to predict histopathology based on clinical features.Results:There were 55 cases of orbital intradiploic cysts, 49 from literature review and six from our cohort. Approximately 31% had dermoid and 69% had epidermoid histopathology. Average age of patients with dermoid cysts was significantly lesser than that of patients with epidermoid cysts (23 vs. 35 years, respectively; P = 0.048). There was no difference between sex predilection, presenting symptoms, radiographic findings, or surgical treatment of dermoids and epidermoids. The majority of patients (64%) underwent craniotomy for surgical removal. Machine-learning algorithms KStar and Neural Network were able to distinguish dermoid from epidermoid with accuracies of 76.3% and 69%, respectively.Conclusion:Orbital intradiploic cysts are more commonly epidermoid in origin. Dermoid cysts presented in younger patients; however, there were no other significant differences in features including ophthalmic or radiographic findings. Despite similar features, machine learning was able to identify dermoid versus epidermoid with good accuracy. Future studies may examine the role of machine learning for clinical guidance as well as new surgical options for intervention.

Orbital and periorbital dermoid cysts: a retrospective analysis of 270 lesions

ABSTRACT Purpose To report the clinical characteristics and intraoperative findings of periorbital and orbital dermoid cysts and their relationship to location and rupture. Methods Retrospective review of 270 cases with orbital or periorbital dermoid cysts that presented over a period of 11 years. Patients were included if diagnosis of dermoid cyst was made by histopathologic analysis. Clinical characteristics and operative outcomes were recorded and analyzed with Chi-squared analyses or univariate regression. Multivariate binary logistic regression was performed to assess predictors of location and rupture. Results Dermoids frequently occurred unilaterally and were more frequently described as mobile (61.5%), followed by fixed (30.8%), and partially fixed (7.7%). Dermoid rigidity was most commonly described as firm (75.5%), followed by cystic, soft, and rubbery. The most common dermoid location was superotemporal (60.4%). On Chi-squared analysis, superotemporal lesions were less likely to have orbital extension than non-superotemporal lesions (OR 0.28, 95% CI: 0.11–0.70, p = .01), less likely to undergo CT (OR 0.16, 95% CI: 0.06–0.41, p < .01) or MRI (OR 0.23, 95% CI: 0.13–0.41, p < .01), more likely to be described as mobile (OR 2.91, 95% CI: 1.32–6.43, p = .01), and less likely to rupture intraoperatively (OR 0.28, 95% CI: 0.11–0.73, p = .01). No variables were associated with rupture in multivariate analysis. Conclusion Superotemporal dermoid cysts are common in the pediatric population, less likely to have orbital extension, undergo imaging, and have intraoperative rupture when compared to other locations in the orbit.

Possible abnormal origin of inferior oblique from a congenital dermoid cyst

A 4-year-old female child presented with a cystic swelling medially along the floor of the orbit with mild ipsilateral medial canthus dystopia on the left side. This swelling was present since birth with no significant orbital dystopia or any extraocular movement defects. During surgery, a trilobed yellowish cyst was found near the inferomedial wall of the orbit. Incidentally, the inferior oblique muscle was found to be originating from the medial lobe of the cyst. The cyst was removed completely, and the inferior oblique was reinserted to the inferomedial orbital margin. Histopathology was consistent with dermoid cyst. To the best of the authors' knowledge, the case of abnormal origin of inferior oblique muscle from an orbital dermoid cyst has not been reported before.

Congenital Conjunctival Cysts of the Orbit.

To evaluate the clinical presentation, anatomical location, and histological features of congenital conjunctival cysts of the orbit. The location and the histological features of inflammation in these patients were compared with those for 293 orbital dermoid cysts. Retrospective review of the clinical details, imaging, and histopathology for patients who had excision of conjunctival cysts from their orbit between 1992 and 2020; patients with a history of trauma or surgery were omitted. Twelve patients (7 male; 58%) with congenital conjunctival cysts were identified, the patients presenting at an average age of 16 years (median 26; range 1-61) with a symptoms for a mean duration of 20 months (median 24; range 6-36). The commonest symptoms were peribulbar lump (6/12 patients; 50%), and eyelid swelling and blepharoptosis (6/12 patients; 50%). An orbitaxl mass was palpable in 10 patients (83%), 3 patients (25%) had mild proptosis (1-3 mm), and the cysts were most commonly located superiorly (6/12 patients; 50%) or superonasally (3/12; 25%) in the anterior half of the orbit. Imaging was performed in 7 cases, this showing an intimate relation to the common sheath of the superior rectus/levator complex in 3 patients (25%) and to the trochlea in 1 (8%). All cysts were excised completely, and no patient had postoperative complications or recurrence. Chronic mild and nonspecific inflammation was evident within the cyst wall in 7 cases (54%), but-unlike 55% of the 293 dermoid cysts-none showed granuloma formation. Congenital conjunctival cysts are rare and usually present with a palpable mass in the upper eyelid sulcus. A significant proportion of these cysts have an intimate relationship with the trochlea, or the superior rectus, levator palpebrae or superior oblique muscles and, to minimize the risk of postoperative diplopia or ptosis, particular care must be exercised during surgery.

Orbital inflammatory disease in a child caused by a ruptured dermoid cyst misdiagnosed as orbital cellulitis

One of the most common orbital tumors in childhood is orbital dermoid cysts. Cyst rupture or leakage of the cyst content is one of therare causes of orbital inflammations and needs to be caught early. A five and a half year old boy was referred to us with the diagnosisof orbital cellulitis resistant to antibiotic therapy. Regarding his detailed medical history, physical examination and laboratory testsfindings, he was diagnosed as orbital inflammatory disease caused by dermoid cyst rupture. He underwent surgical excision of thecyst after the inflammation was resolved with a short course of anti-inflammatory treatment. Although, it is rare, dermoid cystrupture is one of the important causes of orbital inflammatory diseases and it must be kept in mind in the differential diagnosis oforbital infections. A detailed history and a careful examination helped us to make the correct diagnosis and avoided diagnostic delayand unnecessary treatment.

Orbital dermoid cyst combined with unilateral keratoconus

To report a rare case of an orbital dermoid cyst combined with unilateral keratoconus. A 19-year-old female presented with a painless, progressive upper eyelid swelling of the right eye accompanied by decreased visual acuity. Keratoconus of the right eye was confirmed by corneal topography. After surgery, the lesion mass proved to be a dermoid cyst on pathological examination. To the best of our knowledge, this is the first report to describe an orbital dermoid cyst combined with unilateral keratoconus. This case suggested that the keratoconus of the right eye may be a secondary manifestation of the mechanical pressure exerted by the orbital dermoid cyst.

Periorbital Mass in a 2-month-old Girl.

Periorbital Mass in a 2-month-old Girl.

A Case Report on Intraorbital Extraconal Dermoid Cyst

Orbital dermoid cyst represents 3 to 4% of all primary orbital tumors. The intraorbital location is relatively rare and it commonly occurs at childhood. We reported the case of a 4-year-old male child with an intraorbital dermoid cyst, who presented with progressive left proptosis, which had noticed 6 months earlier. Visual acuity, ocular motility and fundoscopic examination were normal. Magnetic resonance Imaging (MRI) revealed an extraconal orbital mass situated on superior &amp; mildly posterior aspect of orbit and which was iso-to-hypointense in T1, hyperintense in T2, restriction of diffusion in DWI, hyperintense signal on ADC (Shine through) and no enhancement after giving contrast. The tumor was completely excised via a left fronto-orbital access. Histopathologically, the tumor was confirmed as dermoid cyst.

Ocular and Periocular Tumors in Asian Indian Children and Adolescents

To describe eye tumors in Indian children (age £ 21 years) presenting to a multi-tier ophthalmology hospital network in India. Hospital-record review. During the 3-year study period (November, 2015-October, 2018), 2911 children were diagnosed with 3003 eye tumors. The three most common benign tumors included conjunctival nevus (445, 22%), orbital dermoid cyst (206, 10%), and periocular infantile capillary hemangioma (181, 9%). The three most common malignant tumors included retinoblastoma (835, 88%), xeroderma pigmentosa related ocular surface squamous neoplasia (38, 4%), and rhabdomyosarcoma (17, 2%). Based on the age group, retinoblastoma (n=834, 28%) was the most common tumor in all groups, except adolescence where conjunctival nevus (n=194, 21%) was the most common. Overall, retinoblastoma is the most common tumor in children encountered in a referral based comprehensive ocular oncology practice in India.

Presentation and Treatment of Deep Orbital Dermoid Cysts

Periocular dermoids usually are preseptal (exophytic)1 and present in infancy, whereas the much rarer deep orbital (endophytic)1 ones often present with inflammation in adulthood.1–5 Using review of records, imaging, and pathologic analysis, we described the characteristics, management, and outcomes for 82 patients with deep orbital dermoid cysts (DODCs) treated at Moorfields Eye Hospital between 1992 and 2017. The study was approved by the institutional review board at Moorfields Eye Hospital (identifier, MEH no.

Ocular and Periocular Tumors in India: An EyeSmart Electronic Medical Record Analysis of 9633 Cases from a Referral Center.

PURPOSE:To describe the epidemiology of ocular and periocular tumors in patients presenting to a multi-tier ophthalmology hospital network in India using the electronic medical records (EMRs) system.METHODS:A retrospective, observational, referral, hospital-based study of 1,142,098 patients. The data were collected using the in-house developed EyeSmart EMR system.RESULTS:During a 6-year study period, 9633 (0.8%) new patients were diagnosed with eye tumors. Of the 9633 patients, 5209 (54%) were male and 4424 (46%) were female. Of all tumors, 6372 (65%) were benign, 282 (3%) were pre-malignant, and 3089 (32%) were malignant in nature, respectively. Overall, the three most common tumors included retinoblastoma (n = 1167, 12%), ocular surface squamous neoplasia (n = 957, 10%), and conjunctival nevus (n = 903, 9%). The three most common benign tumors included conjunctival nevus (n = 903, 9%), eyelid nevus (n = 358, 4%), and orbital dermoid cyst (n = 344, 4%). The three most common malignant tumors included retinoblastoma (n = 1167, 12%), ocular surface squamous neoplasia (n = 957, 10%), and sebaceous gland carcinoma (n = 202, 2%). The most common tumor in 0–10 years' age group was retinoblastoma (n = 1163, 42%), 11–30 years was conjunctival nevus (n = 408, 16%), and > 30 years was ocular surface squamous neoplasia (n = 801, 17%), respectively.CONCLUSIONS:The present study results indicate the incidence and distribution of ocular and periocular tumors in a large cohort in India. Retinoblastoma is the most common tumor encountered in a referral-based comprehensive ophthalmic oncology practice in India. The use of EMRs enables to capture the structured information and big data analysis of the same.

Orbital and periorbital dermoid/epidermoid cyst: a series of 280 cases and a brief review

ObjectiveTo report one of the largest case series on periorbital and orbital dermoid/epidermoid cyst and to highlight some important and unusual findings. MethodsRetrospective analysis of 280 cases with orbital or periorbital dermoid/epidermoid cyst that presented over a period of 14 years. ResultsPeriorbital cyst was more than twice as common as orbital cyst. Majority of patients had bony changes with some unusual findings seen in cases with orbital cysts, that is, presence of fluid-fluid level, calcification in the wall, and coexistent double cysts in 19 (6.8%), 5 (1.8%), and 4 (1.5%) cases, respectively. Dumbbell dermoid cyst with connection in temporal fossa was seen in 16 (5.7%) cases. Subperiosteal location of orbital dermoid cyst was most destructive because of extensive bony invasion. Most of the periorbital cysts were removed in toto, whereas orbital cysts required decompression before removal. The histopathological diagnosis was dermoid cyst in 250 (89%) cases and epidermoid cyst in 30 (11%) cases. In 69 (25%) cases, there was a chronic inflammatory response. ConclusionsWe recommend imaging in all patients with orbital dermoid to rule out dumbbell or subperiosteal extension. Also, we advocate early removal of all dermoid cysts in view of bone changes seen in majority of our cases and presence of inflammatory cells in 25% of cases.

The spectrum of orbital dermoid cysts and their surgical management

ABSTRACT Purpose The purpose of this study is to describe a spectrum of surgical approaches to orbital dermoid cysts, influenced by the anatomic location of the expanded cyst wall and other factors. Methods In this retrospective case series, we reviewed cases of dermoid cysts surgically excised during a 39-year period (1977–2016). Cysts were categorized according to the location of the expanded cyst wall and other considerations. The impact of these factors on surgical management was determined. Results We identified six dermoid cyst growth patterns based on the anatomic location of the expanded cyst wall that influence the surgical approach: anterior to the frontozygomatic suture (FZS), superior to the FZS, medial to the FZS and other lateral wall sutures, traversing the FZS and other lateral wall sutures, nasoglabellar, and sinus tract from the orbit to the skin. Two additional factors influencing surgical methodology included satellite inflammatory pseudocysts and recurrence after surgical resection. Conclusion Orbital dermoid cysts are not monolithic lesions. Functional and aesthetic outcomes can benefit from considering the anatomic pattern of cyst wall expansion and other factors in their surgical management.

Orbital dermoid cyst presenting as chronic osteomyelitis

A dermoid cyst is a choristoma that arises from the displacement of ectoderm to a subcutaneous location along embryonic closure lines. Rarely dermoids have a deep intraorbital component that is connected to a superficial component through a defect in bone, also known as dumbbell dermoid. We report the case of a young boy who was misdiagnosed having chronic osteomyelitis of the zygoma, based on the clinical and radiological features. On surgical exploration he was found to have a dumbbell-shaped dermoid with a bony defect. Histopathological features were consistent with a diagnosis of dermoid cyst with chronic inflammation.

Sensitivity of Computed Tomography for the Assessment of Spontaneous Dermoid Cyst Localized Rupture with Granulomatous Reaction

ABSTRACTPurpose: To assess the sensitivity of computed tomography for the diagnosis of spontaneous localized orbital dermoid cyst rupture with granulomatous reaction. Methods: The charts of 42 patients with dermoid cysts were reviewed retrospectively. The data collected included demographics, clinical features, CT imaging, and postoperative histopathological analysis of the lesions. The association between radiological signs of inflammation and histopathological evidence of an inflammatory reaction was tested by univariate logistic regression. Results: Localized spontaneous rupture with granulomatous reaction occurred in 61.9% of patients. The median age of patients with spontaneous rupture was significantly higher than the age of patients who had no histopathological evidence of rupture. Bone scalloping was significantly associated with preoperative rupture. Fat contents had a protective effect. Large sizes increased the odds of rupture. Conclusion: Bone remodeling and histopathological evidence of spontaneous preoperative rupture were significantly associated. Since age, cyst size, and contents are factors contributing to rupture, surgical removal is suggested for dermoids with liquid contents.

Unsuspected Conjunctival Orbital Dermoid Cyst: Aids in Diagnosis

A 25-year-old man with Type 1 diabetes mellitus experienced rapid visual decline and was scheduled for right cataract surgery. At the time of administering an inferotemporal retrobulbar block, a white discharge appeared spontaneously on the surface of the globe. Superotemporally a cyst was found and its contents were subtotally evacuated. Microscopically, eosinophilic, acellular material with chatter artifact and small vacuoles was detected and initially thought to represent a lens choristoma. This material stained moderately with the periodic acid Schiff method and was focally Congo red positive without apple green birefringence; it also stained blue with the Masson trichrome method. Acid-fast staining disclosed the presence of rare vellous hairs. Adherent cells were not epidermal cells (CK5/6) but conjunctival epithelial cells (CK7); CD68-positive histiocytes were also identified. The lesion was diagnosed as a disrupted orbital dermoid cyst of conjunctival origin.

Clinical Outcomes of Ruptured Periorbital and Orbital Dermoid Cysts.

To evaluate the clinical outcomes of ruptured dermoid cysts. A multicenter, retrospective study of all cases of periorbital and orbital dermoid cysts with histopathological evidence of rupture, including those with clinical rupture, was performed over a 10-year period. Demographics and clinical outcomes of ruptured dermoid cysts were recorded. Persistent inflammation was defined as the presence of edema, erythema, and discomfort for at least 28 days. Eighty-six cases of dermoid cysts were identified. Median age was 5.5 (range, 1-63) years. Location of cyst was either periorbital (n = 60, 70%) or orbital (n = 26, 30%). There were 29 cases with clinically apparent rupture: 27 surgically ruptured (93%) and 2 spontaneous rupture (7%). Persistent inflammation was found in 1 spontaneous cyst rupture case (50%) and 1 surgically ruptured cyst (3.7%). Older age (p = 0.01) and bony attachment (p = 0.001) were significant factors for cyst rupture, while there was no influence from cyst location (p = 0.14). Persistent inflammation is uncommon after surgical rupture of dermoid cysts, but likely after spontaneous rupture. Older age and bony attachment are risk factors for cyst rupture.

Orbital Dermoid Cyst: Classification and its Impact on Surgical Management

ABSTRACTPurpose: Analysis of different clinical types of orbital dermoid cyst, and studying the impact of preoperative classification on the proposed surgical procedure. Methods: A retrospective study of orbital dermoid cyst cases. The clinical and imaging data were reviewed. The different types of dermoid were recorded as superficial or deep, lateral or medial, exophytic or endophytic. The deep dermoids were classified according to their site and continuity of the cyst wall. The operative approach, intraoperative, and/or postoperative complications were recorded. Results: The study included 153 cases of orbital dermoid. The superficial lesions represented 68.6%, of which 74.3% were lateral and 61.0% were endophytic. Intraoperative cyst perforation was recorded in 56.3% of exophytic cases approached through crease incision, and recurrence occurred in 6.3%. Defective cyst wall was found in 31.25% of deep orbital dermoid. Surgery was complicated by cyst rupture when excision was attempted, and recurrence was recorded in one case. Exposure, intended evacuation, and dissection of the cyst wall were better surgical approaches for these cases without reported complications. Conclusion: Preoperative classification of orbital dermoid had an important effect on the surgical procedure. Endophytic superficial lesions were approached through crease incision without complications, while exophytic lesions were better approached through infrabrow incision. Deep orbital lesions with defective wall were better approached through exposure, intended evacuation, dissection, and excision of the remaining cyst wall.