Orbital and periorbital dermoid/epidermoid cyst: a series of 280 cases and a brief review.

OBJECTIVE

To report one of the largest case series on periorbital and orbital dermoid/epidermoid cyst and to highlight some important and unusual findings.

METHODS

Retrospective analysis of 280 cases with orbital or periorbital dermoid/epidermoid cyst that presented over a period of 14 years.

RESULTS

Periorbital cyst was more than twice as common as orbital cyst. Majority of patients had bony changes with some unusual findings seen in cases with orbital cysts, that is, presence of fluid-fluid level, calcification in the wall, and coexistent double cysts in 19 (6.8%), 5 (1.8%), and 4 (1.5%) cases, respectively. Dumbbell dermoid cyst with connection in temporal fossa was seen in 16 (5.7%) cases. Subperiosteal location of orbital dermoid cyst was most destructive because of extensive bony invasion. Most of the periorbital cysts were removed in toto, whereas orbital cysts required decompression before removal. The histopathological diagnosis was dermoid cyst in 250 (89%) cases and epidermoid cyst in 30 (11%) cases. In 69 (25%) cases, there was a chronic inflammatory response.

CONCLUSIONS

We recommend imaging in all patients with orbital dermoid to rule out dumbbell or subperiosteal extension. Also, we advocate early removal of all dermoid cysts in view of bone changes seen in majority of our cases and presence of inflammatory cells in 25% of cases.