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A 7-year-old boy with a right anterior orbital mass
Digital Journal of Ophthalmology 2010
Volume 16, Number 3
August 30, 2010
DOI: 10.5693/djo.03.2010.02.001
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Ibrahim F. Hitti, MD | Syosset Hospital
Janusz I. Sawicki, MD | Syosset Hospital
Differential Diagnosis
Space-occupying masses of the orbit can be divided into cysts, inflammatory lesions, and solid tumors.

• Dermoid and simple epithelial cysts are the most common orbital lesions in the pediatric population. In a series of 250 cases by Shields et al., dermoid cysts accounted for 46% of childhood orbital lesions and 89% of all cystic lesions.(1) These figures may be even higher in the practice of a general ophthalmologist. The majority of these cystic lesions are superficial and confined to the anterior orbit. Superficial dermoid cysts are diagnosed clinically by their typical presentation: a non-tender, mobile mass at the outer orbital rim in a young child.(2) They are best removed intact by an anterior approach through a superior eyelid crease incision.(3) Deep dermoid cysts are detected at a later age, and they are in surgically challenging locations often requiring a lateral orbitotomy with a higher risk of injury to orbital and ocular tissues.
• Orbital mucoceles are secondary cysts. They arise from chronically inflamed paranasal sinuses, and they usually develop in adulthood, except in patients with cystic fibrosis where a presentation in childhood is possible.
• Parasitic cysts such as cysticercosis and hydatid cysts occur usually in endemic areas such as Mexico, Central and South America, and India.
• Inflammatory lesions accounted for 16% in the series by Shields et al.; they are usually biopsied to exclude the diagnosis of rhabdomyosarcoma.(1)
• Although rhabdomyosarcoma is not a common orbital space-occupying lesion in children, one should be familiar with its clinical features: sudden onset of painless proptosis with impairment of ocular motility and non-axial displacement of the globe. Immediate biopsy is indicated. In the above-mentioned case series, there were 14 primary malignant tumors (6%), 10 of which were rhabdomyosarcoma.(1)