By Paul T. Finger, MD
Epibulbar dermoids are benign tumors. They tend to be firm, white-yellow or pinkish tumors straddling the limbus in the temporal (primarily inferotemporal) quadrants. They are located both over the cornea and sclera. They can range from several millimeters to over a centimeter in size. They are typically unilateral (found on one eye), but can be bilateral.
Dermoids are choristomas (normal tissues that are in the wrong place). Made up of cutaneous and subcutaneous tissue, it is not uncommon for dermoids to contain hair and other skin structures. These tumors can be found on the eye, adnexa and orbit.
Dermolipomas are more commonly found in the superotemporal quadrant extending to the lacrimal gland and/or orbit.
Most patients with epibulbar dermoid or dermolipomas have no symptoms unless hairs or other dermal structures cause local irritation. The lesions do cause a cosmetic defect.
The diagnosis of dermoid and dermolipoma is made by ophthalmic examination. These lesions are typically present at birth and do not progress. Though ultrasound and radiographic imaging may be required to investigate the extent of the tumor, biopsy is not necessary.
Dermoids or dermolipomas are more likely to be associated with Goldenhar’s Syndrome if they are multiple or bilateral. Goldenhar Syndrome is associated with dermoid tumors at the tragus of the ear and facial dysostosis.
It is very important to make sure your child does not have a secondary astigmatism related to corneal tumor involvement. Early treatment of astigmatism can prevent amblyopia (loss of vision).
Surgery can be performed to limit the cosmetic defect, but there are many reports of secondary complications related to thinning of the scleral “eye wall” and corneal astigmatism.
Surgical removal of dermolipomas (that can extend into the lacrimal gland and orbit) can be associated with lacrimal gland dysfunction (dry eye) and double vision. Care must be taken to preserve the overlying conjunctiva and lacrimal gland.
Dermoids and dermolipomas can be associated with Goldenhar Syndrome or Linear Nevus Sebaceous Syndrome.