Orbital Tumors - Dermoids

Dermoid cyst on the skin

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

Post - Operative, sutures and dermabond in place

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 lead to 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 pull up 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 lead to 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

Orbital Tumors - Dermoids Compare with EPIDERMOID