A dermoid cyst, briefly known as a choristoma, is the presence of normal cells in areas where they should not be found. They are congenital and tend to grow slowly. They contain hair follicles, sebaceous glands, sweat glands, and primitive structures like teeth. They are found in approximately 45% of cases within the eye socket and are the most common orbital tumors. Although they are usually located on the outer part of the orbit and just below the eyebrow, they can be found anywhere in the orbit.
What symptoms do dermoid tumors cause?
- Families often seek medical attention due to a noticeable mass around the eye.
- These masses are typically painless.
- If the mass is adherent to the underlying bone, it is immobile; if not adherent, it can move when pressure is applied with a finger.
- It can cause deformity of the eyelid.
- It can lead to eyelid drooping (ptosis).
- If these cysts rupture due to trauma or excessive rubbing, they can cause severe reactions around the eye, resulting in excessive swelling, redness, and bruising. Rupture of the cyst is a situation that should be avoided at all costs.
Are dermoid tumors malignant or benign?
Dermoid cysts are benign tumors. They can grow, but they do not spread to other parts of the body. However:
- Since they are congenital tumors, they can affect the development of the surrounding bones in the area where they are located, leading to facial and ocular asymmetry.
- As the tumor grows, it can exert pressure on structures such as the eye and the muscles, blood vessels, and nerves around it, causing other problems.
- They can also cause eyelid drooping, leading to lazy eyes.
- Sometimes, these tumors can be located very close to the skin and can rupture due to trauma or excessive rubbing. This can trigger a foreign body reaction around the eye.
- If the tumor is close to the inner part of the eye, it can sometimes produce hair, which can scratch the transparent layer of the eye and cause damage.
- In some cases, they can develop deep within the orbit, causing the eye to protrude forward or exert pressure on the muscles around the eye, leading to double vision.
How is the diagnosis of dermoid tumors established?
Congenital masses are often easily noticed by families, especially when they are superficially located in the orbit. However, deep orbital masses may go unnoticed by families. We conduct a general eye examination. Through palpation, we determine the location of the mass, its connection to underlying tissues, whether it causes double vision, eyelid drooping, or bone deformities. We usually perform an MRI and sometimes an orbital CT scan to support the diagnosis, understand the size of the mass, and its relationship with surrounding tissues. While these tests help us make a diagnosis with a high degree of certainty, the definitive diagnosis is established after the mass is surgically removed and its pathology is examined.
Is surgery required for dermoid tumors?
For the many reasons mentioned above, it is necessary to remove these masses and examine their pathology. It is preferable to remove the mass completely and, if possible, without rupturing it. If the mass is very small and does not pose a problem for the eye and the tissues around it, it can be monitored without surgery.
Is the surgery performed under local or general anesthesia?
Since these patients are mostly young children, we perform the surgery under general anesthesia. However, in some cases, surgery can be performed under local anesthesia for adults who have not been operated on before. Patients do not need to stay in the hospital after surgery. We remove the stitches one week after the surgery. After surgery, patients may experience minor issues such as swelling, bruising, and slight edema for about a week.
Can dermoid tumors recur after surgery?
If the tumor is completely removed without rupturing it, it will not recur. However, if it is not completely removed or if the tumor content spreads around during surgery due to the rupture of the surrounding membrane, unfortunately, it can recur. In such cases, a second surgery is required.