Orbital Cyst

Orbital Cysts

Orbital cysts is presented as a painless swelling in the lateral angle of an orbit which gradually increases in size. Usually there is no pain over the swelling.

On examination the swelling can be globular in shape, fluctulant and non-transilluminate.

Factors which shows signs of orbital cysts:

The overlying skin stays free. 

The cysts indents on pressure.

There is bony indendation at the margin of the orbit around the swelling.

Diagnosis and other possibilities:

It may be:

• Sebaceous cyst
• Meningocele
• Lipoma 
• Fibroma
• Neurofibroma

Dermoid cyst occur at the lines of embryonic fusion, whereas sebaceous cyst may occur at any site.

Dermoid cyst lies in subcutaneous tissue and is free from the skin. 

Dermoid Cysts

The sebaceous cyst lies deep to the epidermis and the skin is usually fixed  to the cyst and there is usually punctum over the skin.

Now if you are suffering from Meningocele your symptoms will be:

• Presence of cough impulse
• Bony gap is palpable
• Swelling is transilluminate.

A sequestration dermoid is formed by sequestration of some ectodermal cells into deeper layer during embryonic development.

These sequestrated cells later proliferate and liquify to form a sequestration dermoid.

A sequestration dermoid cyst is lined by stratified squamous epithelium, which may contain hair follicles, sweat and sebaceous glands. 

The cyst contains a toothpaste like material which is a mixture of desquamated epithelial cells, sweat and sebum.

During development of the cyst the surrounding mesodermal tissue may be compressed causing indendation on the bone, which develops from mesoderm. 

Dermoid cyst is also known as a true cyst because it is lined by squamous epithelium with hair follicles, sebaceous glands and sweat glands.

The wall of the cyst is lined by a layer of epidermis oriented with the basal layer superficially and more mature layers lying deep.

The false cyst is fluid filled sac not lined by epithelium. 

This may be lined by granulation tissue or fibrous tissue. 

This includes pseudopancreatic cyst, cystic degeneration of tumour. 

Large orbital dermoid cysts

Excise of cyst:

• Usually done under local anesthesia but maybe done under general anesthesia if there is intracranial extension.
• An elliptical skin incision is made keeping an island of skin over the swelling. 
• The two skin flaps are raised on either side up to the margin of the cyst.
• The cyst is then excised and hemostasis is secured.
• Skin closed by interrupted non-absorbable suture.