Dermoid Cyst

Magnetic Resonance Imaging (MRI). An MRI scan uses a combination of large magnets, radio waves, and computer imaging to provide clear images of the affected parts.

What to Know About Dermoid Cysts Around the Eyes

A dermoid cyst around the eyes usually forms when the baby is in the uterus. This article explains the ways dermoid cysts are formed, their causes, symptoms, and possible treatment options.

What Is a Dermoid Cyst?

A dermoid cyst is an abnormal growth of non-cancerous tissue under the skin. These cysts may contain hair follicles, skin tissue, sweat, and oil. Sometimes cysts also contain teeth and bones. Although these cysts may form in different parts of your body like your head, neck, or face, they’re most commonly found in the eyes.

The cysts are typically present at birth but may grow over time. Dermoid cysts have two types.

Orbital dermoids. These are usually found at the end of the eyebrows, near the nose, where the bones of the eye socket are located. Orbital dermoids form below the skin’s surface and are not directly visible. These cysts are smooth, contain a greasy yellow substance, and are usually not painful. They are not known to cause any loss in vision, but removal of dermoid cysts from the eyes is vital, as they grow larger over time.

Sometimes, orbital dermoids may be dumbbell-shaped. In such incidences, one section forms outside the eye socket while the other forms on the inside. Orbital dermoids may burst and cause inflammation, so doctors recommend removing them right away. According to research, dermoid cysts are one of the most commonly occurring orbital tumors in children, making up roughly 45% of all childhood neoplasms (abnormal tissue mass).

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Epibulbar dermoids. These cysts are further grouped into two types, posterior epibulbar dermoids and limbal dermoids. The first type is a cyst that usually contains some hair and takes the shape of the eye. These cysts are commonly found on the outer part of the upper eyelid. You’ll be able to see these cysts only during certain eye movements.

Limbal dermoid cysts grow on the eye, either in the cornea or the point where the cornea and sclera join. Limbal dermoids may hamper a child’s vision as they grow larger and can also modify the shape of the cornea. This leads to an eye condition called astigmatism, which blurs your vision. If astigmatism is not treated in time, your brain gets used to this blurry vision causing a condition known as lazy eye (amblyopia).

Dermoid Cysts in the Eyes: Causes

Dermoid cysts are a congenital condition and are present at the time of birth. They are typically formed due to a disruption affecting how the skin layers grow together.

Cysts are formed during the early phases of the child’s growth in the uterus. Skin cells, tissues, and glands are parts of the skin that come together to form a lump. These glands keep producing fluids that cause the lump to grow even larger and form cysts. So, one of the easiest ways to understand dermoid cysts is to think of them as skin stuck under the surface.

Dermoid Cyst Symptoms

A dermoid cyst is commonly found as a lump that is visible in the affected area. In most cases, the cyst is painless, but sometimes, it may put pressure on the eyeball that could cause pain and affect your child’s vision. These cysts are nothing but a collection of skin cells and tissues. They continue to carry out the same actions as other skin, though, releasing oil and discarding old cells. When the enlarged dermoid cyst grows into the bone (usually the skull), the gap in the affected bone also becomes wider as the cyst grows.

How Are Dermoid Cysts Diagnosed?

Doctors generally carry out a physical examination to pinpoint the location and appearance of the cyst and inspect other parts of your child’s eyes. A physical inspection usually reveals an orbital dermoid cyst. Ophthalmologists (eye doctors) typically look for some of the following signs:

• A rubbery growth over the eyebrow or near the nose
• A droopy eyelid
• Inflammation in the eye

Your doctor may also run specific tests to identify whether your child has deeper dermoid cysts and locate them. Some of these tests include:

X-ray. This gives the doctor a clear view of the areas where the cysts are formed.

Computerized Tomography (CT) scan. A CT scan and an x-ray create detailed images of the affected area.

Magnetic Resonance Imaging (MRI). An MRI scan uses a combination of large magnets, radio waves, and computer imaging to provide clear images of the affected parts.

CT and MRI scans are non-invasive tests and give your doctor accurate images of the cyst. This tells them if the cyst is near a sensitive area such as a nerve and helps them decide on the most suitable treatment method.

Dermoid Cysts in the Eyes: Treatment

Some dermoid cysts may affect your child’s vision while others could burst and cause further complications. In such cases, your doctor may recommend surgery to remove the errant tissue.

Posterior epibulbar dermoids are typically linked to the conjunctiva (the outer lining of your eyeball right under the eyelids) of your child’s eye. Sometimes, it may extend right up to the eye socket and cannot be removed completely. Your doctor will decide if surgery would be beneficial. If so, they may only partially remove the cyst.

Limbal dermoids may need to be removed completely, as they affect the cornea. Removing dermoid cysts from the eyes restores vision in most cases. It also reduces any discomfort and irritation that was present before surgery. However, in many cases, limbal dermoids permanently change the shape of the cornea, and there could be a recurrence of amblyopia in such instances.

Schedule regular follow-up appointments with your doctor after surgery to make sure your child gets proper care. In many cases, vision can be restored if a condition is detected early.

Key Points to Remember About Dermoid Cysts

Dermoid cysts around the eyes are benign but should be attended to right away to avoid further complications.

• Dermoid cysts are non-cancerous tissues that form during the early stages of your child’s growth in the uterus.
• Two types of dermoid cysts affect the eyes – orbital and epibulbar. These cysts may affect your child’s vision as they become larger over time. In some cases, they may rupture and cause inflammation.
• While removing dermoid cysts surgically is recommended in many cases, check with your doctor to find the best treatment options for your child.
• Keep in mind that some cysts may recur even after successful surgery. In such cases, follow-up care from your doctor is critical.

Show Sources

American Academy of Ophthalmology: “Dermoid Cyst.”

American Association for Pediatric Ophthalmology & Strabismus: “Dermoid Cyst.”

Cleveland Clinic: “Dermoid Cysts.”

Nationwide Children’s Hospital: “What is a Dermoid Cyst?”

Riley Children’s Health: “Dermoid Cysts & Other Periocular Tumors.”

Stanford Medicine: “Dermoid Cyst in Children.”

Dermoid Cyst

Dermoid cysts occur when tissue collects under the skin. These cysts may contain hair, teeth or nerves. They usually appear at birth. Dermoid cysts often form on your head and neck but may also be in your ovaries, on your spine or elsewhere in your body. Though dermoid cysts are usually harmless, providers often remove these cysts with surgery.

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Overview

What is a dermoid cyst?

A dermoid cyst is a growth of normal tissue enclosed in a pocket of cells called a sac. This tissue grows in or under your skin in an unexpected location.

Dermoid refers to something that’s like skin. A cyst is a lump or bump that may contain fluid or other material. Most often, dermoid cysts contain a greasy yellow material, but they may contain:

• Bone.
• Fluid.
• Hair.
• Nerves.
• Skin.
• Sweat glands.
• Teeth.

Dermoid cysts can be anywhere on your body. The ones close to your skin surface may look like small lumps. People can also develop dermoid cysts deeper inside your body.

At first, a dermoid cyst can seem like a tumor, but these cysts usually aren’t harmful. You or your child may need surgery to remove a dermoid cyst. It won’t go away on its own.

What are the types of dermoid cysts?

More than 8 out of 10 dermoid cysts occur on the head and neck. The most common type of dermoid cyst is a periorbital dermoid cyst. This type of cyst occurs near the outside edge of one of your eyebrows.

Other common dermoid cyst types include:

• Ovarian dermoid cyst: Occurs on or in your ovary.
• Spinal dermoid cyst: Forms on your spine.

Rarer types of dermoid cysts include:

• Epibulbar dermoid cyst: Found on the surface of your eye.
• Intracranial dermoid cyst: Found in your brain.
• Nasal sinus dermoid cyst: Forms inside your nose.
• Orbital dermoid cyst: Occurs around the bones of your eye socket.

Who might get a dermoid cyst?

Anyone can get a dermoid cyst, but healthcare providers diagnose about 7 in 10 dermoid cysts in children under age 5. Healthcare providers diagnose about 4 in 10 dermoid cysts at birth.

Symptoms and Causes

What causes a dermoid cyst?

Dermoid cysts are present at birth (congenital). These cysts occur when skin layers don’t grow together as they should. This happens during the early stages of development in the uterus (fetal development).

For a dermoid cyst to form, skin cells, tissues and glands typically found in skin collect in a sac. These glands continue to produce fluid, often causing the cyst to grow.

What are the symptoms of a dermoid cyst?

Many people with dermoid cysts have no symptoms. Some people start to experience symptoms as their cysts grow. Symptoms vary based on the type of dermoid cyst. For example:

Periorbital dermoid cyst: A lump near the edge of your eyebrow may be swollen and have a yellow tint. Over time, it can change the shape of bones in the area.

Ovarian dermoid cyst: You may have pain in your pelvic area, particularly around the time of menstruation.

Spinal dermoid cyst: A growing dermoid cyst may compress your spinal cord or nerves, causing:

• Trouble walking.
• Urinary incontinence.
• Weakness in your legs and arms.

Diagnosis and Tests

How is a dermoid cyst diagnosed?

To help diagnose you or your child’s condition, your healthcare provider will ask about symptoms. Your provider can diagnose a dermoid cyst in different ways depending on the cyst’s location:

• Physical exam: If the cyst is close to your skin’s surface, your provider can examine the cyst and the area around it.
• CT (computed tomography) scanormagnetic resonance imaging (MRI): These noninvasive tests show your provider images of the cyst. These tests can show if the cyst is near a sensitive area, such as a carotid artery. They can also see if a spinal dermoid cyst may be near a nerve.
• Pelvic ultrasoundor transvaginal ultrasound: Your provider uses painless sound waves to see images of an ovarian dermoid cyst. During a pelvic ultrasound, your provider applies a probe against your skin. During a transvaginal ultrasound, your provider inserts a wand into your vagina.

Management and Treatment

How is a dermoid cyst treated?

Surgical removal is the only effective treatment for any type of dermoid cyst. The type of surgery depends on the kind of dermoid cyst:

• Periorbital dermoid cyst: Your provider cleans the area and injects a local anesthetic. They remove the cyst through a small incision. They close the incision with stitches so it can heal with as little scarring as possible.
• Ovarian dermoid cyst: Your provider may use minimally invasive surgery (ovarian cystectomy) to remove the cyst without removing your ovary. If the cyst is large, you may need removal of both your ovary and the cyst.
• Spinal dermoid cyst: Your provider will use a surgical microscope and precise instruments (microsurgery) to remove the cyst. During the surgery, you lie face down so your surgeon has good access. You’ll be asleep during the surgery with general anesthesia.

Prevention

How can I reduce my risk of a dermoid cyst?

Dermoid cysts are congenital (present at birth). You can’t reduce the chances of a dermoid cyst.

Outlook / Prognosis

What can I expect if I have a dermoid cyst?

Untreated dermoid cysts usually don’t cause any harm. But over time, dermoid cysts may cause complications, especially if they grow. Complications can include:

• Damage to nearby bones.
• Infection.
• Injury to the spinal cord or nerves.
• Rupture (bursting open) of the cyst.
• Twisting of the ovaries (ovarian torsion).

Dermoid cyst surgery is usually a safe procedure. Having your or your child’s cyst removed can help manage any symptoms and prevent future complications. If you have an ovarian dermoid cyst that needs removal, talk to your provider about how surgery could affect your fertility.

Living With

When should I see my healthcare provider?

See your provider if you or your child has any new symptoms or if symptoms worsen. Seek medical treatment immediately if a cyst:

• Becomes inflamed.
• Causes pain.
• Changes color or gets bigger.
• Ruptures.

What else should I ask my doctor about dermoid cysts?

To understand this condition, you may want to ask:

• What’s the most appropriate treatment?
• Can a cyst come back after treatment?
• What’s the recovery time after dermoid cyst surgery?

A note from Cleveland Clinic

Dermoid cysts are usually harmless, but some may cause complications depending on their size and location. If you or your child has a dermoid cyst, talk to your healthcare provider about the best ways to treat it. Your provider can often remove a dermoid cyst through surgery. Cyst removal can reduce the chance of having symptoms in the future.

Last reviewed by a Cleveland Clinic medical professional on 10/05/2021.

References

• American Association for Pediatric Ophthalmology and Strabismus. Dermoid Cyst. (https://aapos.org/glossary/dermoid-cyst) Accessed 10/11/2021.
• Jacków J, Tse G, Martin A, et al. Ruptured intracranial dermoid cysts: a pictorial review. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334092/) Pol J Radiol. 2018;83:e465-e470. Accessed 10/11/21.
• Seok Choi J, Chan Bae Y, Woo Lee J, Bin Kang G. Dermoid cysts: Epidemiology and diagnostic approach based on clinical experiences. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258973/) Arch Plast Surg. 2018 Nov;45(6):512-516. Accessed 10/11/2021.
• Shareef S, Ettefagh L. Dermoid Cyst. (https://www.ncbi.nlm.nih.gov/books/NBK560573/) [Updated 2021 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Accessed 10/11/2021.

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