An orbital dermoid cyst is a benign growth that is present at birth. These lumps are typically found near the eye socket, specifically around the eyebrow or the upper and outer corner of the orbit. They are characterized by their slow-growing nature and usually do not cause immediate problems upon discovery.
Causes and Development
Orbital dermoid cysts originate during the earliest stages of fetal development. During this period, skin cells, known as ectoderm, become mistakenly trapped along the lines where different parts of the embryo fuse together.
Their formation is a natural occurrence in embryonic development and is not linked to any actions or inactions by the parents during pregnancy. This developmental error simply results in a small sac containing skin-like elements within the orbital region.
Symptoms and Diagnosis
An orbital dermoid cyst typically presents as a smooth, firm, and non-tender lump that can be moved slightly under the skin. It is most commonly located on the upper and outer edge of the eye socket, near the eyebrow or temple area.
The diagnostic process begins with a thorough physical examination conducted by a pediatrician or an ophthalmologist. To confirm the diagnosis and determine the cyst’s full extent, imaging tests are frequently employed. Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scans are particularly useful in visualizing the cyst’s precise size and depth. These scans help ascertain if the cyst extends deeper into the orbit behind the eye or, in rare cases, into the cranial cavity, which influences treatment planning.
Treatment and Removal
The standard and most effective treatment for an orbital dermoid cyst is surgical excision, which involves completely removing the cyst. Surgical intervention is recommended for several reasons, including preventing potential rupture of the cyst, stopping its gradual enlargement, and for cosmetic considerations. Removing the cyst also allows for a definitive diagnosis through pathological examination of the excised tissue.
The surgical procedure is typically performed by an oculoplastic surgeon or a pediatric ophthalmologist, often on an outpatient basis. During the surgery, the incision is carefully planned to minimize visible scarring, frequently placed within a natural skin crease, such as an eyelid crease or along the eyebrow. The surgeon meticulously dissects the cyst from the surrounding tissues, ensuring its complete removal to prevent recurrence.
Following the surgical removal, a smooth recovery process is generally expected. Patients might experience some swelling and bruising around the eye, which usually subsides within a few weeks. Post-operative care involves keeping the surgical site clean and following specific instructions regarding activity limitations to promote optimal healing and reduce discomfort.
Potential Complications
If an orbital dermoid cyst is left untreated, it can gradually increase in size over many years. While most cysts remain stable, a growing cyst might eventually cause noticeable cosmetic asymmetry or, in very rare instances, exert pressure on the eye structures. Such pressure could potentially affect vision or eye movement, particularly if the cyst extends deeper into the orbit.
A more immediate concern with an untreated cyst is the risk of rupture, which can occur spontaneously or due to trauma to the area. When a dermoid cyst ruptures, its contents, including fatty material and hair, leak into the surrounding tissues. This leakage triggers a significant inflammatory reaction known as granulomatous inflammation.
This inflammatory response manifests as acute pain, redness, and swelling around the affected eye. The body’s immune system reacts strongly to the foreign material, leading to a noticeable and often uncomfortable localized reaction. Managing a ruptured cyst often requires medical intervention to address the inflammation and remove the irritating contents.