Orbital Tumors - Dermoids

Pre operative photo: note {the} mass along {the} left, outer bro w

5 days after surgery, sutures in place


  1. benign cystic lesions that are choristomas (tumors composed of tissues not usually found at {the} involved site)
  2. originate at bony suture sites during embryogenesis as a result of surface skin elements becoming entrapped
  3. usually found in early childhood (25% are noted at birth), but can also be diagnosed in adults
    • in adults, they often involve {the} deep orbital tissues and grow to a very large size
  4. Not to be confused with Epidermoid cysts which are   similar but lack certain elements in {the} wall of {the} cyst 

Differential Diagnosis

  • encephalocele
  • lacrimal mass/tumor
  • lacrimal mass or tumor

Work-up / Course / Prognosis

  1. CT/MRI imaging reveals characteristic round to oval shaped cystic lesion with a defined lining
  2. Symptoms
    • painless
    • slow-growing
  3. signs
    • typically do not displace {the} globe
    • typically do not raise intraocular pressure
  4. locations
    • occur in {the} superotemporal  orbit ({the} most common site, 70% )
    • {the} superomedial orbit
    • deep orbit
  5. Trauma may possibly lead to leakage of {the} cystic contents and likely will result in acute inflammation


  1. Lining
    • {the} cysts are lined by keratinizing, stratified squamous epithelium (85% of lesions), or
    • nonkeratinized stratified squamous epithelium
  2. Filling
    • filled with keratin
    • hair shafts are usually present in lumen or wall of cyst (99%)
    • sebaceous glands are usually present in lumen or wall of cyst (75%)
    • sweat glands are often present in lumen or wall of cyst (20%)


  1. surgical excision is {the} treatment of choice. With complete excision, {the} prognosis is excellent.
  2. usually once they child has reached age 12 months


Compare with EPIDERMOID


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