Cystic Lesions of the Orbit: Dermoid and Epidermoid Cysts

1 Signs and Symptoms

A painless mass may be present around the eye or orbital bones; this may be soft, firm, moveable, or fixed to the deeper tissue. Orbital dermoid cysts may induce proptosis and strabismus. Leaking or ruptured dermoid cysts may present as orbital cellulitis. Lesions may also fistulize to the skin [1,2,3].

2 Differential Diagnosis

Infection: orbital cellulitis. Malformation: epidermoid cyst, dermolipoma, and lipoma. Benign vascular tumor: hemangioma. Vascular malformation: lymphatic, venous, or lyphatico-venous. Neoplasm: rhabdomyosarcoma, other sarcomas.

3 Diagnosis

Patients may present with either a visible mass in the ocular adnexa or with proptosis or some other vertical or horizontal globe displacement. Some orbital dermoid cysts are completely asymptomatic and are only discovered inadvertently on orbital imaging for some other indication. Dermoid cysts are typically in the region of a bony suture. The mass can be palpable firm (or sometimes soft) and sometimes...