Dados do Trabalho

Título

DEEP ORBITAL DERMOID CYST: A CASE REPORT

Objetivo

To report a rare case of orbital dermoid cyst, considering its deep location, age of diagnosis and surgical treatment.
The aim of this report is to highlight dermoid cysts as a differential diagnosis in cases of deep orbital cystic lesions, showing a clinical and radiological presentation as well as the surgical outcome after its removal.

Relato do caso

55 year-old brazilian man was admitted in oculoplastics service referring painless proptosis of the right eye started one year ahead of admission. He denied diplopia or recent visual loss. He stated no comorbidities nor prescription drugs intake.
Old pictures revealed gradual proptosis of many years and he stated right eye bad vision since his childhood.
External examination revealed S-shaped deformity in the right eyelid associated with convergent strabismus and palpable non-pulsatile supratemporal mass with inferior and medial displacement of the globe.
On examination, best corrected visual acuity was 20/200 in the right eye and 20/20 in the left eye.
Right extraocular motility was restricted in all fields of look but specially in dextroversion and dextrosupraversion. Herthel exophtalmometry was 35 mm in the right eye and 24 mm in the left eye (base 110 mm).
Slit-lamp examination was unremarkable, but mild inferior conjunctival hyperemia in the right eye.
He had no relative afferent pupillary defect and fundus examination revealed choroidal folds in the right eye.
Computed tomography scan revealed a large cystic lesion occupying most of the supra-temporal aspect of right orbit reaching close to the apex resulting in proptosis and pushing the optic nerve medially. In addition, there was a bony spicule of the right lateral orbital wall.
Surgery was performed by lateral orbitotomy aproch. Patient received postoperative combined oral antibiotic/steroid treatment for one week.

Discussão

Stratified squamous epithelium lines dermoid cysts, as in epidermoid cysts. Unlike epidermoid cysts, however, they also have epidermal appendages such as hair follicles, sweat glands, and sebaceous glands. The latter are responsible for the secretion of sebum which imparts the characteristic appearance of these lesions on CT and MRI.
Treatment and prognosis depend on size, location and involvement of orbital structures. While superficial lesion may barely requires a cosmetic excision, a deeper one may require more invasive methods involving micro-dissection, orbitotomy, and rarely, intracranial exploration if the lesion extends to that extent.