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Published on Apr 28, 2022 - 6 min read
Abstract
The dermoid eye cyst is an epithelium-lined cavity filled with ectodermal components. Read the article below to know more about dermoid eye cysts.
A dermoid cyst of the eye is congenital (since birth) choristoma. Choristomas are tumor-like growth of normal cells in an abnormal location. Dermoid cysts are structures originating from ectoderm like hair follicles, keratin, sweat, and sebaceous glands. More than eighty percent of the dermoid cysts occur in the head and neck region, out of which dermoid cysts of the eye are the most common. The dermoid cysts of the eyes include orbital, conjunctival, and corneal cysts. Most common among them are the orbital dermoid cysts, whereas conjunctival and corneal cysts are uncommon.
Sequestration (inclusion) of epithelium embryologically is the leading cause of dermoid eye cysts. In addition, there is entrapment of epithelial cells during the closure of frontomaxillary, frontotemporal and frontozygomatic sutures.
The three significant dermoid eye cysts differ in their epithelium lining and internal structure. The different types of dermoid cysts are:
Orbital Cyst: In orbital cysts, sequestration of the squamous epithelium occurs. It is a cystic lesion.
Conjunctival Cyst: It is lined by conjunctival epithelium containing goblet cells. It is a solid tumor.
Corneal Cyst: It is lined by squamous epithelium and has ectodermal and mesodermal structures (from mesoderms like blood vessels, fat cells, and cartilage) components. It is a solid tumor.
All three cysts show changes in their site of appearance, time of occurrence, and specific signs and symptoms.
Following are the clinical features of the different types of dermoid eye cyst:
Orbital - It becomes apparent only in the first decade of life. It is mostly asymptomatic, but there may be diplopia if it is present inside the orbit. They are slow-growing, painless, firm masses present in the lateral aspect of the eyebrow and fixed to the underlying bone. An orbital dermoid cyst may sometimes leak material into the surroundings resulting in inflammatory reactions.
Conjunctival - These tumors begin at birth but only appear in the 40s. The tumor is a soft, fluctuant subcutaneous mass. It is present in the superonasal aspect of the orbit.
Corneal - They present clinically as white or yellowish, solid, smooth surface mass protruding from the eyeball. Corneal cysts are primarily located in the corneal region. Sometimes, corneal cysts are so large that they prevent the expected closing of the eye.
Some of the typical clinical signs which may appear in patients suffering from all the three types of dermoid cysts of the eye include:
Palpable mass.
Ptosis (drooping of the upper eyelid).
Proptosis (bulging eyes).
Strabismus (cross eyes).
Pulsating proptosis with mastication.
Globe displacement.
Restriction in extraocular movements.
Orbitocutaneous fistula.
The orbital and corneal dermoid cysts occur in various forms clinically.
1. Orbital Dermoid Cyst:
Based on the depth of invasion:
Superficial - Present as a smooth, painless mass in superotemporal and are more common. It can be mobile or fixed to the underlying bone.
Deep - Deep cysts may remain occult and appear only in adulthood. When they enlarge, they might produce ptosis, strabismus, and diplopia.
Based on the size of the tumor:
Small - These cysts are mostly asymptomatic and regress by themselves.
Large - These larger cysts might sometimes displace the globe.
Based on the location of the suture to the surrounding bone and soft tissue:
Juxtasutural - The cyst is present near the sutural lines.
Sutural - The cyst is present on the suture.
Soft Tissue - The tissue is present on the soft tissue.
Based on the type of growth:
Exophytic - Exophytic dermoid cysts grow externally.
Endophytic - Endophytic dermoid cysts grow internally.
2. Corneal Cysts:
Based on their severity of clinical presentation:
First Grade of Severity - These cysts are present only on the superficial layers of the limbus and cornea.
Second Grade of Severity - These cysts cover the cornea fully.
Third Grade of Severity - They are large dome-like cysts plunging between the eyelids.
The dermoid cysts of the eye pose several risks to the patient depending upon their size and extent.
The orbital dermoid cyst may sometimes penetrate the frontal sinus by passing through the roof of the orbit.
In the case of a large cyst, part of the cyst is in orbit, and the other part is in the temporal fossa connected by a defective bone known as the dumbbell orbital cyst.
The orbital dermoid cysts can form fistulas with the adjacent skin of the cyst and drain the contents of the cyst into the fistula.
Leakage of the cystic content into the surrounding lesion elicits a primary inflammation.
Corneal cysts are associated with Goldenhar-Gorlin syndromes (congenital syndrome affecting the bones of the face).
It can be easily detected by clinical examination. However, radiographic diagnostic procedures also play a vital role in the cyst's confirmatory diagnosis. These include:
Computed Tomography (CT): It is mainly used to assess the bony changes occurring inside the cyst and the bone's rims and margins. It also helps recognize dumbbell cysts (cysts that have their contents on both sides of bone with communication between them). CT shows a non-enhancing lesion with smooth margins. Conjunctival cysts do not display any abnormal findings in CT if it is not in contact with the bone.
Magnetic Resonance Imaging (MRI): They help appreciate the size and shape of the cyst with the fat suppression technique.
The removal of dermoid cysts of the eye may minimize the cosmetic compromise and risk of amblyopia and recurrent inflammation linked with the cysts.
For all cysts, the treatment of choice is surgical excision. However, the mode of treatment for a particular cyst depends upon the cyst size that might include the following:
A small cyst with no symptoms does not require any treatment. They may regress spontaneously.
Surgical excision with the lining intact is ideal for removing a large cyst.
The cyst's contents should be drained first for a considerably large cyst, followed by surgical excision.
Orbital Epidermoid Cyst: They are lined by squamous epithelium but lack the presence of hair and sebaceous glands inside the cavity.
Orbital Mucocele: Orbital mucoceles occur primarily in adults, and often patients have a history of trauma.
Orbital Dermolipoma: It is a benign fat tumor of the eye present in the conjunctiva.
Lacrimal Tumors: Benign tumors occurring in the lacrimal gland.
Orbital dermoid cysts have a good prognosis. Surgical excision does not cause further complications and exhibits very few recurrence rates.
Surgical excision of the dermoid eye cyst can cause a few post-surgical complications. Some of these complications include -
Spillage of the cystic contents during the surgery can initiate a granulomatous inflammatory reaction.
After surgery, the occurrence of ecchymosis (discoloration in the skin due to bleeding beneath the skin post-trauma).
Incomplete removal of the cyst leads to recurrence of the cyst.
Formation of orbitocutaneous fistula due to the presence of residual dermoid tissue after removing the cyst.
Conclusion:
Dermoid eye cysts are benign eye tumors. They originate from the ectodermal germ layer due to the inclusion of epithelium during fetal development. They are diagnosed both clinically and radiographically. Clinically, they appear as smooth, painless masses. Dermoid cysts are cured surgically with a minimal recurrence rate. It is essential to seek the advice of a healthcare provider if you experience any of the symptoms of a dermoid eye cyst.
The best choice of treatment for the removal of orbital cysts is surgical removal that is preceded by diagnosis. In the case of large cysts, first, the contents of the lesion are drained, followed by surgical removal.
Dermoid cysts are not a serious condition. They are slow-growing, painless, firm masses seen in several regions of the body. Dermoid cysts are harmless lesions. They are tumor-like growth of normal skin cells in abnormal locations.
Dermoid cysts are harmless and benign conditions and tend to grow slowly. They are a type of choristoma. Choristomas are tumor-like growth of normal cells in abnormal locations.
Dermoid cysts are present at birth, but sometimes they appear clinically in adults. The age group in which there the dermoid cysts occur normally is between 15 years to 40 years. Orbital and conjunctival dermoid cysts occur in children immediately after birth.
Dermoid cysts clinically appear as yellow or white solid masses in the orbit, conjunctiva, or the corneal region of the eye, as well as in several other regions of the body. They are slow-growing, painless masses that can sometimes be large enough to displace the normal anatomy.
Small lesions without any symptoms do not require any treatment as they may regress spontaneously. However, large lesions are managed by surgical excision.
In the case of a very large cyst, first, the contents are drained, followed by excision and surgical removal.
Dermoid cysts are a type of congenital cysts. Congenital cysts are lumps or masses present in the head and neck region from birth. Dermoid cysts may not always present clinically at birth. Sometimes they appear clinically only in adulthood.
Ovarian dermoid cysts in females are linked to the irregular menstrual cycle. The abnormality in the periods presents clinically as acne, growth of hair all over the body, and thinning of scalp hair.
Dermoid cysts are usually present at birth and usually get completely resolved after surgical removal of the cyst. They have a tendency to recur in case of incomplete removal of the cystic contents. Ovarian dermoid cysts have a higher recurrence rate in children and adolescents.
Most dermoid cysts can be detected clinically. Apart from the clinical diagnosis, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound are also helpful. A biopsy is a gold standard for diagnosing a cyst.
The pathogenesis of the dermoid cyst also has a genetic basis. In most cases, at least one first-degree relative of the family is also predisposed to contracting the condition.
Surgical removal of the dermoid cyst is safe. The time taken by the patient to recover depends upon the type of suturing, if the cyst area after removal is left open, it takes several months to heal, whereas closed stitches heal within four weeks.
Dermoid cysts are slow-growing cysts. They are sac-like growth of skin and its structures. They may present early in life, usually at birth, but grow slowly to a substantial size in adulthood.
When dermoid cysts are very large, they usually displace the anatomical structure out of its place, this results in the compression of any nearby nerve, which leads to the onset of pain. Rupturing of the cyst is also related to the spreading of infection, leading to pain.
An ovarian dermoid cyst is a mature type of teratoma. Teratomas are germ cell tumors that contain mature or immature skin and bony structures such as teeth, hair, bone, etc. It affects people of wide age groups.
Rupture of the dermoid cyst, such as the ovarian and abdominal dermoid cyst, is often accompanied by a sudden, intense sharp pain in the abdomen. In the case of the ovarian dermoid cyst, it can be lethal. It can also cause infection in the surrounding regions.
A dermoid cyst of the ovaries can be best treated with surgical removal. Patients with ovarian dermoid cysts overall have a good chance of getting pregnant. The dermoid cyst does not affect fertility.
Ovarian dermoid cysts, in rare cases, have a tendency to secrete hormones like the adrenocorticotropic and human chorionic gonadotropin hormones. The secretion is due to the presence of pituitary cells inside the cyst.
Dermoid cysts are heterogenous cysts. They have both soft tissue and hard tissue components such as skin, sebaceous glands, hair, teeth, and bone structures present in them. In imaging, it usually appears like a teratoma.
Dermoid cysts of the head and neck region, if not removed, lead to cosmetic compromise. A dermoid cyst, if left untreated, can grow large enough to displace the normal structure from its place and can also cause infection to the surrounding structures.
Orbital dermoid cysts are sac-like cavities that are formed due to the entrapment of the epithelium lining the different parts of the eyes, including the cornea, conjunctiva, and the orbit, during the closure of the suture.
Dermoid cysts, which are very small, may resolve by themselves. Large cysts require surgical intervention for their removal. They do not disappear by themselves. They may recur if the removal of the cyst is not complete.
Dermoid cysts are composed of structures formed from the outermost germ layer, also known as the ectodermal layer. It comprises hair follicles, teeth, bony structure, sweat glands, sebaceous glands, and keratin.
Very large dermoid cysts are preferred to be surgically removed. Surgery is recommended for ovarian cysts measuring at least 2.4 inches in diameter. Dermoid cysts above 5 cm in size are eligible for surgical removal.
Dermoid cysts are the most common cysts occurring in newborns. Dermoid cysts of the periorbital and orbital region are the most frequently encountered cysts seen in newborns.
Very large dermoid cysts are recommended to be surgically removed as early as possible. Surgical removal of the cyst should be performed only when the newborn attains six months of age.
Last reviewed at:
28 Apr 2022 - 6 min read
RATING
Dentistry
Comprehensive Medical Second Opinion.Submit your Case
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