Dermoid, Orbital Clinical Presentation

  • Author: Talmadge (Ted) Cooper, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: May 3, 2010
 

History

  • Patients generally complain of a mass, which is visible in the orbital area. Growth of these lesions is generally slow. Occasionally, a history of inflammation will be present.
  • In adults, dermoids may become symptomatic for the first time and grow considerably over a year. Based on this fact, some conclude that these lesions may be dormant for many years or have intermittent growth.
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Physical

  • Children
    • The most common location is in the superior temporal aspect of the orbit.
    • The mass is generally less than 1 cm in diameter, nontender, and oval in shape.
    • Little displacement of the globe usually occurs.
    • Orbital dermoid cysts are not attached to the skin, which helps differentiate them from sebaceous cysts. The cyst usually is tethered to the periosteum of the bone near suture lines, including the sinuses or intracranial cavity.
  • Adults: The cysts are palpated less easily and have more vague borders. They are more likely to displace the globe and may erode their way into adjacent structures.
  • Inflammation
    • If the cyst ruptures, either spontaneously or with trauma, an inflammatory response may be seen. This response may be limited to injection of the conjunctiva or may be severe and mimic orbital cellulitis. Occasionally, subconjunctival droplets of fat are seen.[2]
  • Neurologic findings
    • Rarely, the cyst may press on the optic nerve and produce symptoms of optic nerve compression; reduced visual acuity, color vision and brightness perception, and a relative afferent pupillary defect.
    • More rarely, the cyst may induce diplopia by physically restricting movement of the globe or by compressing cranial nerves III, IV, or VI.
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Causes

  • No known causes for orbital dermoid exist.
  • Other diagnostic considerations
    • Ruptured dermoid cysts may mimic rhabdomyosarcoma.
    • Pediatric metastatic cancers
    • Orbital cellulitis
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Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Talmadge (Ted) Cooper, MD  Adjunct Clinical Associate Professor, Department of Ophthalmology, Stanford Medical School

Talmadge (Ted) Cooper, MD is a member of the following medical societies: American Academy of Ophthalmology and American College of Medical Informatics

Disclosure: Nothing to disclose.

Specialty Editor Board

Jorge G Camara, MD  Professor of Ophthalmology, Department of Surgery and Director of Fellowship Training Program in Ophthalmic Plastic and Reconstructive Surgery for Countries Served by the Aloha Medical Mission, University of Hawaii John A Burns School of Medicine

Jorge G Camara, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and American Society of Ophthalmic Plastic and Reconstructive Surgery

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Mark T Duffy, MD, PhD  Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic

Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience

Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Shields JA, Shields CL, Scartozzi R. Survey of 1264 patients with orbital tumors and simulating lesions: The 2002 Montgomery Lecture, part 1. Ophthalmology. May 2004;111(5):997-1008. [Medline].

  2. Jung BY, Kim YD. Orbital dermoid cysts presenting as subconjunctival fat droplets. Ophthal Plast Reconstr Surg. 2008;24(4):327-9. [Medline].

  3. Chawda SJ, Moseley IF. Computed tomography of orbital dermoids: a 20-year review. Clin Radiol. Dec 1999;54(12):821-5. [Medline].

  4. Chung EM, Smirniotopoulos JG, Specht CS, Schroeder JW, Cube R. From the archives of the AFIP: Pediatric orbit tumors and tumorlike lesions: nonosseous lesions of the extraocular orbit. Radiographics. Nov-Dec 2007;27(6):1777-99. [Medline]. [Full Text].

  5. Neudorfer M, Leibovitch I, Stolovitch C, Dray JP, Hermush V, Nagar H, et al. Intraorbital and periorbital tumors in children--value of ultrasound and color Doppler imaging in the differential diagnosis. Am J Ophthalmol. Jun 2004;137(6):1065-72. [Medline].

  6. Golden RP, Shields WE 2nd, Cahill KV, Rogers GL. Percutaneous drainage and ablation of orbital dermoid cysts. J AAPOS. Oct 2007;11(5):438-42. [Medline]. [Full Text].

  7. Prabhakaran VC, Hsuan J, Selva D. Endoscopic-Assisted Removal of Orbital Roof Lesions via a Skin Crease Approach. Skull Base. Sep 2007;17(5):341-5. [Medline]. [Full Text].

  8. McNab A. Manual of Orbital and Lacrimal Surgery. Butterworth-Heinemann Medical; 1998.

  9. Rootman J. Orbital Surgery: A Conceptual Approach. Raven Press; 1995.

  10. Schick U, Hassler W. Pediatric tumors of the orbit and optic pathway. Pediatr Neurosurg. Mar 2003;38(3):113-21. [Medline].

  11. Shields JA, Shields CL. Orbital cysts of childhood--classification, clinical features, and management. Surv Ophthalmol. May-Jun 2004;49(3):281-99. [Medline].

  12. Sreetharan V, Kangesu L, Sommerlad BC. Atypical congenital dermoids of the face: a 25-year experience. J Plast Reconstr Aesthet Surg. 2007;60(9):1025-9. [Medline]. [Full Text].

 
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Temporal-zygomatic suture line on the lateral orbital wall. The location of the periosteal attachment of most orbital dermoids.
 
 
 
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