Dermoid, Orbital Workup

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

Imaging Studies

  • Radiography: Radiographs often show radiolucent defects where the cyst has eroded into bone. These defects can be large with distinct margins and may show sclerotic changes.
  • CT or MRI studies have largely supplanted plain radiography for evaluating dermoid cysts.
    • A review of 160 CT studies of orbital dermoids revealed that 65% were lateral and 30% were medial to the globe, only one was entirely behind the globe, 85% had changes in adjacent bone, 73% had a visible wall, 27% had a CT attenuation similar to orbital fat, 14% had calcification, 5% had a fluid level, and 20% had abnormal soft tissue outside the cyst.[3]
    • On MRI, features include a cystic appearance, internal fat attenuation (T1 hyperintensity), internal calcification, and fluid levels.[4] These features are uncommon in rhabdomyosarcoma.
  • Ultrasound characteristics of dermoid cysts include a smooth contour and variable echogenicity.[5]
  • Color Doppler imaging of dermoid cysts shows no intralesional blood flow, which can help differentiate them from hemangioma and rhabdomyosarcoma.[5]
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Histologic Findings

The external layer of the cyst has variable thickness and may be exceedingly thin. The cyst is generally 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.

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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.

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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