Dermoid, Orbital

Author: Talmadge (Ted) Cooper, MD; Chief Editor: Hampton Roy Sr, MD more...

Updated: May 3, 2010

What would you like to print?

Background
Pathophysiology
Epidemiology
Show All

Background

Dermoid and epidermoid cysts are examples of choristomas, tumors that originate from aberrant primordial tissue. These tumors contain normal-appearing tissue in an abnormal location. As two suture lines of the skull close during embryonic development, dermal or epidermal elements may be pinched off and form cysts, which are adjacent to the suture line (this is shown in the image below). Approximately 50% of dermoids that involve the head are found in or adjacent to the orbit.

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

Pathophysiology

Orbital dermoid cysts may displace structures in the orbit, especially the globe. If the displacement is great, interference with vision by compression of the optic nerve may result or ocular motility may be disturbed, resulting in diplopia.

Frequency

United States

At an ocular oncology center, dermoid tumors were found to comprise 2% of the orbital tumors that came to surgery.^[1]

Mortality/Morbidity

Orbital dermoid cysts almost never cause death.
Morbidity is usually of a cosmetic nature; occasionally, loss of vision, diplopia, or orbital inflammation may occur.

Race

Dermoid tumors show no racial predilection.

Sex

Dermoid tumors have an equal incidence in males and females.

Age

These tumors are most often noted in young children; however, they may appear or grow at any age.

Proceed to Clinical Presentation

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

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].
Jung BY, Kim YD. Orbital dermoid cysts presenting as subconjunctival fat droplets. Ophthal Plast Reconstr Surg. 2008;24(4):327-9. [Medline].
Chawda SJ, Moseley IF. Computed tomography of orbital dermoids: a 20-year review. Clin Radiol. Dec 1999;54(12):821-5. [Medline].
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].
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].
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].
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].
McNab A. Manual of Orbital and Lacrimal Surgery. Butterworth-Heinemann Medical; 1998.
Rootman J. Orbital Surgery: A Conceptual Approach. Raven Press; 1995.
Schick U, Hassler W. Pediatric tumors of the orbit and optic pathway. Pediatr Neurosurg. Mar 2003;38(3):113-21. [Medline].
Shields JA, Shields CL. Orbital cysts of childhood--classification, clinical features, and management. Surv Ophthalmol. May-Jun 2004;49(3):281-99. [Medline].
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].