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Dermoid, Orbital: Differential Diagnoses & Workup

Author: Talmadge (Ted) Cooper, MD, Adjunct Clinical Associate Professor, Department of Ophthalmology, Stanford Medical School
Contributor Information and Disclosures

Updated: Jan 28, 2009

Differential Diagnoses

Exophthalmos
Lacrimal Gland Tumors
Optic Neuropathy, Compressive
Sebaceous Gland Carcinoma
Thyroid Ophthalmopathy
Tumors, Orbital

Other Problems to Be Considered

Mucocele
Encephalocele
Echinococcus cyst
Sebaceous cyst

Workup

Imaging Studies

  • X-ray films often show radiolucent defects where the cyst has eroded into the bone. These defects can be large with distinct margins and may show sclerotic changes.
  • CT or MRI studies have largely supplanted plain x-ray studies for evaluating dermoid cysts. These studies may be indicated, if the posterior extent or the cyst cannot be palpated. On MRI, features include a cystic appearance, internal fat attenuation (T1 hyperintensity), internal calcification, and fluid levels. All of these features are uncommon in rhabdomyosarcoma.
  • Orbital ultrasound may be useful and avoid the need for the more expensive CT or MRI studies.

Histologic Findings

The external layer of the cyst has variable thickness and may be exceedingly thin. The cyst is connected to periorbita by fibrovascular tissue. Epidermoid cysts have a lining of epithelial cells, usually stratified, that produce keratin. Dermoid cysts contain blood vessels, fat, collagen, sebaceous glands, and hair follicles. The material in the cyst varies from a tan oily liquid to a white or yellow substance that resembles cottage cheese or even a relatively solid mass. Often, high cholesterol content is present. The cysts commonly are inflamed and may contain free blood.

More on Dermoid, Orbital

Overview: Dermoid, Orbital
Differential Diagnoses & Workup: Dermoid, Orbital
Treatment & Medication: Dermoid, Orbital
Follow-up: Dermoid, Orbital
Multimedia: Dermoid, Orbital
References
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References

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

  2. 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].

  3. 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].

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

  5. 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].

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

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

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

  9. 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].

  10. 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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Further Reading

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Keywords

orbital dermoid cysts, epidermoid cysts, dermoid cysts, orbital tumors, choristoma, epidermoid

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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.

Medical Editor

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.

Pharmacy Editor

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.

Managing Editor

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; Quest medical - lacrimal balloons Honoraria Speaking and teaching; Ortho-Neutrogenia Consulting fee Consulting

CME Editor

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.

 
 
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