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Year : 2022  |  Volume : 4  |  Issue : 1  |  Page : 3

Eyelid dermoid cyst: Case report of a rare manifestation

1 Madras Medical College, Chennai, Tamil Nadu, India
2 Divisional Railway Hospital, Department of Ophthalmology, Visakhapatnam, Andhra Pradesh, India

Date of Submission08-Nov-2021
Date of Decision29-Nov-2021
Date of Acceptance29-Nov-2021
Date of Web Publication13-Jan-2022

Correspondence Address:
Dr. Eshwar Rajesh
Madras Medical College, Chennai, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/pajo.pajo_118_21

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Dermoid cysts are epidermis-like cysts with dermal adnexal structures such as sebaceous glands, hair follicles, or sweat glands in the cyst wall. They contain mature or immature germ cells of pluripotent origin. The usual sites of occurrence in the periorbital region include the lateral angle of the orbit, medial angle, limbal, and deep orbital region. Here, we present a case of 16-year-old female who came to the hospital with complaints of swelling in the upper eyelid and intermittent pain. After an excisional biopsy of the mass was done, the diagnosis of tarsal dermoid cyst was confirmed. Due to the paucity of cases in literature, reporting this case may help shed light on the importance of including dermoid cyst in the differential diagnosis of a tarsus-based eyelid mass.

Keywords: Choristoma, dermoid cyst, eyelid, tarsal dermoid

How to cite this article:
Rajesh E, Charumathi R. Eyelid dermoid cyst: Case report of a rare manifestation. Pan Am J Ophthalmol 2022;4:3

How to cite this URL:
Rajesh E, Charumathi R. Eyelid dermoid cyst: Case report of a rare manifestation. Pan Am J Ophthalmol [serial online] 2022 [cited 2023 Sep 27];4:3. Available from: https://www.thepajo.org/text.asp?2022/4/1/3/335853

  Introduction Top

Dermoid cysts are categorized as developmental choristomas that harbor abnormally arranged tissues. They develop as a result of sequestration of surface ectodermal elements during the closure of fetal suture lines in embryogenesis.[1] The head and neck account for 7% of all dermoid cysts, with 70% of them occurring in the periorbital zone.[2] They are usually benign noninvasive lesions which rarely cause damage. On histopathological examination, they are usually found to have stratified squamous epithelium with dermal appendages and adnexal structures. Koreen et al. were the first to describe a dermoid cyst associated with tarsus in 2009.[3]

  Case Report Top

A 16-year-old female presented to the hospital with complaints of swelling in the right upper eyelid [Figure 1] for a duration of about 1 year. The swelling had increased in size in the past 6 months and was associated with intermittent pain. On examination, there was a 1.5 cm × 1 cm firm, nontender swelling at the junction of medial 2/3rd and lateral 1/3rd of the upper eyelid 0.5 cm above the margin. Asymmetry of the upper eyelid margin was present – pseudoptosis (right eye lower than left eye). There was no diplopia or diminution of visual acuity. Rest of the ophthalmic examination of both eyes revealed no other significant abnormality. Computed tomography orbit was done to rule out orbital involvement and bone erosion. Following this, we proceeded to do an excision biopsy. A horizontal incision parallel to the margin of the upper eyelid was made on the eyelid crease about 1.5 cm in length. Intraoperatively, it was noticed that the cyst was attached to the tarsus by a stalk. The cyst was removed en bloc along with the capsule without spilling the contents [Figure 2] and [Figure 3]. Hair follicles and white teeth-like material was observed, suggestive of dermoid cyst [Figure 4]. Histopathological analysis revealed cystic lesion, lined by keratinizing squamous epithelium. Pilosebaceous structures and a hair follicle are detected beneath the epithelium. It was consistent with the diagnosis of dermoid cyst. After a follow-up 5 weeks later, the site had healed without scarring.
Figure 1: Clinical presentation of right upper lid swelling

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Figure 2: Intraoperative image during excision

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Figure 3: Postoperative image after excision and closure

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Figure 4: Gross specimen of eyelid dermoid cyst

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  Discussion Top

Dermoid cyst is a benign heterotopic inclusion cyst. Although orbit and periorbital regions are quite common locations for dermoid cyst, the tarsal dermoid cyst is a very unusual presentation and is considered a rarity. Periocular and orbital dermoid cysts are generally categorized into superficial and deep lesions.[4] There have been only 3 cases of tarsal dermoid cysts reported associated with the upper eye lid[3],[5] and 1 case associated with the lower eyelid.[6] A full excision of an intact capsule is the only cure for dermoid cysts.[7] In our case, there were no pressure symptoms or obstruction of any kind. However, cysts located in the deep orbit may cause proptosis, compression of optic nerve or restriction of intraocular movements.[8]

  Conclusion Top

The present case shows an extremely rare cause for an eyelid mass. Through this report, we would like to shed light on such an unusual location for a dermoid cyst. Although it is a rare condition, it must be considered in the differential diagnosis of eyelid mass lesion to avoid misdiagnosis and should be treated appropriately.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflict of interest

There are no conflicts of interest.

  References Top

Cantor L, Rapuano C, Cioffi G. Pediatric ophthalmology and strabismus. In: Basic Clinical and Science Course. San Francisco: American Academy of Ophthalmology; 2013. p. 343-4.  Back to cited text no. 1
Sherman RP, Rootman J, Lapointe JS. Orbital dermoids: Clinical presentation and management. Br J Ophthalmol 1984;68:642-52.  Back to cited text no. 2
Koreen IV, Kahana A, Gausas RE, Potter HD, Lemke BN, Elner VM. Tarsal dermoid cyst: Clinical presentation and treatment. Ophthalmic Plast Reconstr Surg 2009;25:146-7.  Back to cited text no. 3
Ahuja R, Azar NF. Orbital dermoids in children. Semin Ophthalmol 2006;21:207-11.  Back to cited text no. 4
Sezenoz AS, Arat YO, Tepeoglu M. An unusual eyelid mass: Tarsal dermoid cyst. Saudi J Ophthalmol 2015;29:312-4.  Back to cited text no. 5
Gonsalves SR, Lobo GJ, Mendonca N. Dermoid cyst: An unusual location. BMJ Case Rep 2013;2013:bcr2013200686.  Back to cited text no. 6
Pryor SG, Lewis JE, Weaver AL, Orvidas LJ. Pediatric dermoid cysts of the head and neck. Otolaryngol Head Neck Surg 2005;132:938-42.  Back to cited text no. 7
Albert DM, Jakobief FA. Principles and Practice of Ophthalmology. Philadelphia: W B Saunder Company; 2000. p. 3072-81.  Back to cited text no. 8


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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