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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.
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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 5.Surgical photograph demonstrating the conjunctival dermoid cyst in the left orbit. |
 | 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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