Orbital and periorbital dermoid cysts: Comparison of clinical features and management outcomes in children and adults

Abstract

Purpose: To compare differences in clinical presentation and management outcomes of orbital and periorbital dermoid cysts in children and adults. Methods: A retrospective interventional comparative consecutive case series. 203 patients in (148 children [Age ⩽18 years] and 55 adults [Age >18 years]), who underwent excision biopsy for orbital/periorbital dermoid cyst were included. Outcome measures included the differences in demography, clinical presentations, radiological features, surgical outcomes and histopathology of cysts between children and adults with dermoid cysts. Results: The mean age noted at excision was 15 years in this cohort of 148 children and 55 adults. Commonest clinical finding observed was a subcutaneous painless mass (94%) and external angular dermoids were commonest in both groups 1 and 2 (51% and 56%). Diminution of vision ( p = 0.007), proptosis ( p = 0.008), extraocular motility limitation ( p = 0.001), strabismus ( p = 0.003) and relative afferent pupillary defect ( p = 0.02) were significantly more in adults. Orbital involvement and dumbbell dermoids were not significantly different between children and adults. Radiologically, bony fossa formation ( p = 0.03), temporal fossa extension ( p = 0.04), full thickness bony defect ( p = 0.03) and intraosseous presentation ( p = 0.005) were significantly more in adults. Comparison of proportion of lesions having intra-operative rupture of dermoid cyst ( p = 0.009) and evidence of inflammation on histopathology ( p = 0.01) were significantly more in adults. However, recurrence rates were not different between children and adults. Conclusions: Dermoid cysts are commoner in children, but can also present in adulthood. Secondary visual, orbital, radiologic changes and intra-operative rupture of dermoid cyst are more common in adults compared to children.