Superficial Dermoid Cyst Mimicking Acquired Dacryocystocele in an Adult

Introduction

Orbital dermoid tumors are choristomas benign growths found predominantly on one side and comprised of skin and its appendages. They develop through the inclusion of ectoderm into mesoderm along suture lines during the embryologic closure of the neural tube [1]. These lesions may be classified as superficial or deep, depending on their location in relation to the orbital septum. Typically appearing as a rounded mass just beneath the skin near the orbital bones, these tumors often microscopically exhibit a lining of stratified squamous epithelial cells containing dermal structures [2]. Dermoid cysts make up 3 – 9% of all orbital masses, and they can occur in various locations within the orbit [1]. This makes them a significant consideration when differentiating orbital tumors. Very rarely do dermoid cysts develop in the medial canthal area. This specific location can sometimes result in the misdiagnosis of a dermoid cyst as an acquired dacryocystocele. Acquired dacryocystoceles are dilated lacrimal sacs that have become blocked either functionally or anatomically at both ends, resulting in edema and tear drainage disruption [3], [4]. In certain instances, dermoid cysts in close proximity to the lacrimal sac can apply external pressure on the drainage system, also causing a blockage of tear flow. Without careful examination, such lesions can be misdiagnosed as a lacrimal sac enlargement, as illustrated by our case of a dermoid cyst mimicking an acquired dacryocystocele.

Publication History

Received: 24 March 2024

Accepted: 22 January 2025

Article published online:
27 March 2025

• References

• 1 Sadeghi Y, Oberic A, Hamedani M. Different locations of dermoid cysts in the orbital region. Klin Monbl Augenheilkd 2015; 232: 489-492
• 2 Pryor SG, Lewis JE, Weaver AL. et al. Pediatric dermoid cysts of the head and neck. Otolaryngol Head Neck Surg 2005; 132: 938-942
• 3 Davies R, Watkins WJ, Kotecha S. et al. The presentation, clinical features, complications, and treatment of congenital dacryocystocele. Eye (Lond) 2018; 32: 522-526
• 4 Singh S, Ali MJ. Congenital Dacryocystocele: A Major Review. Ophthalmic Plast Reconstr Surg 2019; 35: 309-317
• 5 Bothra N, Wagh RD, Ali MJ. Masquerades of Acquired Dacryocystocele. Clin Ophthalmol 2020; 14: 1855-1858
• 6 Kim NJ, Choung HK, Khwarg SI. Management of dermoid tumor in the medial canthal area. Korean J Ophthalmol 2009; 23: 204-206
• 7 Nowak R, Nowak-Gospodarowicz I, Rekas M. et al. Lacrimal Sac Reconstruction Using a Nasal Mucosal Graft. Ophthalmic Plast Reconstr Surg 2022; 38: e150-e152
• 8 Nowak R, Nowak-Gospodarowicz I, Kicinska A. et al. Niedrożność dróg łzowych – Podstawy diagnostyki i leczenia. Warszawa: Medical Education; 2022