J Korean Ophthalmol Soc.  2010 Apr;51(4):601-605. 10.3341/jkos.2010.51.4.601.

A Case of Conjunctival Dermoid Cyst of the Orbit

• Lee SH
• Kim KH
• Kim SY

• KMID: 2213405
• DOI: http://doi.org/10.3341/jkos.2010.51.4.601

Abstract

PURPOSE
To report a case of primary conjunctival dermoid of the superonasal orbit.
CASE SUMMARY
A 41-year-old man complained of swelling of the left lower eyelid and left periocular pain for a week. Examination revealed 3 mm of proptosis with superotemporal displacement of the left eye. Orbital CT revealed a 32x27x33-mm well-defined giant cyst with a fat-fluid level in the superonasal aspect of the left orbit. Orbital MRI showed bone remodeling around the cyst, consistent with a dermoid cyst. The cyst was approached via lateral orbitotomy and transcaruncular incision but was ruptured just prior to the end of the dissection and was totally excised using a cryoprobe to freeze the ruptured site. Upon histopathological examination, the cyst was misdiagnosed as a conjunctival cyst because there was no dermal appendage but was rediagnosed as a conjunctival dermoid cyst after the tissue sample was examined more thoroughly. After surgery, the patient presented with diplopia due to esodeviation and was prescribed prismatic lenses.

Keyword

Conjunctival cyst; Conjunctival dermoid; Dermoid cyst; Orbital cyst

MeSH Terms

Adult
Bone Remodeling
Dermoid Cyst
Diplopia
Displacement (Psychology)
Esotropia
Exophthalmos
Eye
Eyelids
Humans
Orbit

Figure

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  Figure 1. External photograph of a 41-year-old man with progressive proptosis and lateral displacement of the left eye.

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  Figure 2. Fundus photograph of the left eye showing choroidal folds at the posterior pole due to globe compression.

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  Figure 3. Preoperative axial (A) and coronal views (B) of orbital CT scan showing a well-defined unilocular giant cyst (red arrow), measuring 32×27×33 mm, occupying the superonasal area of the left orbit.

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  Figure 4. Preoperative axial view of orbital MRI reveals a well-defined cyst of the nasal orbit showing high signal intensity on T1-(left) and relatively homogenous enhanced on post-contrast fat suppressed T1-weighted image (right). Globe compression and bone remodeling are seen.

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  Figure 5. Surgical photograph demonstrating the conjunctival dermoid cyst in the left orbit.

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  Figure 6. Gross finding of the completely excised conjunctival dermoid cyst which was accidentally perfo-rated and aspirated during operation.

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  Figure 7. Microscopic examination of cyst wall shows a triple layer of nonkeratinizing stratified epithelium with underlying loose connective tissue. Definite goblet cells and dermal appendages are not seen (hematoxylin and eosin stain, ×400).

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  Figure 8. Microscopic examination of cyst wall. The cyst is lined by nonkeratizing epithelium and has dermal appendages (sebaceous glands) (hematoxylin and eosin stain, ×200).

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  Figure 9. External photograph showing mild esodeviation and enophthalmos in the left eye 2 months after surgery.

Reference

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