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Abstract
Case summary
A 41-year-old man complained of swelling of the left lower eyelid and left periocular pain for a week. Examination revealed 3 mm of proptosis with superotemporal displacement of the left eye. Orbital CT revealed a 32×27×33-mm well-defined giant cyst with a fat-fluid level in the superonasal aspect of the left orbit. Orbital MRI showed bone remodeling around the cyst, consistent with a dermoid cyst. The cyst was approached via lateral orbitotomy and transcaruncular incision but was ruptured just prior to the end of the dissection and was totally excised using a cryoprobe to freeze the ruptured site. Upon histopathological examination, the cyst was misdiagnosed as a conjunctival cyst because there was no dermal appendage but was rediagnosed as a conjunctival dermoid cyst after the tissue sample was examined more thoroughly. After surgery, the patient presented with diplopia due to esodeviation and was prescribed prismatic lenses.
References
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Figure 1.
External photograph of a 41-year-old man with progressive proptosis and lateral displacement of the left eye.
Figure 2.
Fundus photograph of the left eye showing choroidal folds at the posterior pole due to globe compression.
Figure 3.
Preoperative axial (A) and coronal views (B) of orbital CT scan showing a well-defined unilocular giant cyst (red arrow), measuring 32×27×33 mm, occupying the superonasal area of the left orbit.
Figure 4.
Preoperative axial view of orbital MRI reveals a well-defined cyst of the nasal orbit showing high signal intensity on T1-(left) and relatively homogenous enhanced on post-contrast fat suppressed T1-weighted image (right). Globe compression and bone remodeling are seen.
Figure 6.
Gross finding of the completely excised conjunctival dermoid cyst which was accidentally perfo-rated and aspirated during operation.
Figure 7.
Microscopic examination of cyst wall shows a triple layer of nonkeratinizing stratified epithelium with underlying loose connective tissue. Definite goblet cells and dermal appendages are not seen (hematoxylin and eosin stain, ×400).
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