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IP International Journal of Ocular Oncology and Oculoplasty


Presentation pattern and management outcome of ocular and periocular dermoid cyst


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Author Details: Rajendra P. Maurya, Sashikant UC Patne, Virendra P. Singh, Mahendra K. Singh, Ritika, Manisha Dwived

Volume : 2

Issue : 2

Online ISSN : 2581-5016

Print ISSN : 2581-5024

Article First Page : 95

Article End Page : 105


Abstract

Purpose: To determine the pattern of clinical and radiological presentation and treatment outcomes of ocular and periocular dermoid cyst.
Materials and Methods: This prospective, international study was conducted in Unit of orbit, Ocular Oncology & Oculoplasty, Department of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University from April 2014 to May 2016. Forty Six (46) patients with suspected dermoid cyst of the globe, orbit and periocular area were enrolled from outpatient department. Their detailed history, ocular examination, laboratory and radiological investigations were done. All lesions were confirmed on histopathological examination after surgical excision. The collected data was entered and analyzed by using SPSS version 13 software for mode of presentation, laterality, anatomical location & type of lesion, radiological finding and treatment outcome.
Results: 46 patients aged between 5 months and 31 years, underwent surgical excision of dermoid, out of which 20 (43.48%) were male and 26 (56.52%) were female. The maximum percentage of patients were in the age group 11-20 yrs. (45.65%) and 1-10 yrs. (39%) Dermoids were left sided in 30 (65.22%) cases and right sided in 16 (34.78%) cases. None of the cases had bilateral involvement. Most common type of dermoid were superficial orbital/periorbital dermoid (21, 45.65%) followed by deep orbital dermoid (12, 26.09%) and limbal dermoid (10, 21.74%). However in 3 (6.52%) cases primary conjunctival dermoid was excised. Out of 10 cases of limbal dermoid, two were associated with Goldenhar's syndrome and one case was associated with eyelid colobama.
In all 10 cases, limbal dermoid was seen in infero-temporal quadrant with larger portion of mass involving cornea without involving visual axis. Superficial orbital/periocular dermoid cyst were mostly located at superotemporal and superonasal area. However deep/intra orbital dermoid were equally located in superonasal and inferonasal orbit. In 32.6% cases CT scan revealed remodeling/scalloping of underlying orbital bone. None of the cases had features of intracranial extension and dumbbell shaped lesion. Majority of patients were asymptomatic, common presentation was palpable mass lesion. However in 17.39% cases nonaxial proptosis was observed. All patients underwent surgical excision. In 5 cases, these was rupture of capsule while dissecting them from periosteum. Recurrence was observed in two cases.
Conclusion: Dermoid cysts are commonest orbital periorbital masses in childhood and typically present in superotemporal or superonasal location. Limbal dermoid are typically located at inferotemporal quadrant. Orbital dermoid should be investigated for localization and to assess the bony defects or intraorbital and intracranial extension. Orbital dermoid should be removed carefully and completely with minimum trauma in order to prevent rupture/recurrence. Always choose appropriate surgical incision for good functional & cosmetic effect.

Key Words:
Choristomas, Dermoid cyst, Dumb bell-dermoid, Limbaldermoid