Clinical decision upon resection or observation of ocular surface dermoid lesions with the visual axis unaffected in pediatric patients

Abstract

Ocular surface or epibulbar dermoid lesions may present as limbal dermoids at the corneal limbus or dermolipomas in the conjunctival fornix. The purpose of this study is to review clinical features of ocular surface dermoids (grade I), with the visual axis unaffected, in pediatric patients, in order to find key features for making clinical decision, either resection or observation. The study involved 13 consecutive patients with limbal dermoids or fornix dermolipomas which did not affect the visual axis, seen in 11 years at a referral-based institution. Eight patients underwent surgical resection at the age, ranging from 1 to 18 (median, 4) years, with concurrent preauricular appendage resection in 3 patients. Limbal dermoids in 6 patients presented dome-shaped elevation from the ocular surface, and extended in inferotemporal quadrant for 1–2 clock hours. The remaining 2 patients showed dermolipomas in the temporal conjunctival fornix. Postoperative astigmatism at the final visit ranged from 0 to 7 (median, 2.9) diopters in 6 patients with limbal dermoids while ranged from 0 to 1 diopters in 2 patients with fornix dermolipomas. All patients with meaningful astigmatism wore glasses before and after the surgery, resulting in no apparent ametropic or anisometropic amblyopia. Observation was chosen in 5 patients with the age at initial visit, ranging from 0 to 2 (median, 1) years, and the age at the final visit, ranging from 2 to 6 (median, 3) years. Flat limbal dermoids, extending for 1–2 clock hours, were noted in 3 patients, a dome-shaped limbal dermoid for 1 clock hour in one, and a fornix dermolipoma in one. Three patients had preauricular appendages. No patient, except for one with a dome-shaped limbal dermoid, showed astigmatism, greater than one diopter. In conclusions, dome-shaped limbal dermoids were excised while flat limbal dermoids observed. The age at surgery varied largely in pediatric patients with limbal dermoids (grade I) or fornix dermolipomas which did not affect the visual axis. The surgical timing was influenced by surgical scheduling for preauricular appendage resection, determined by a plastic surgeon. Surgical decision was made for cosmetic purposes, but not for medical needs to avoid amblyopia.

Photorefraction with Spot Vision Screener versus Visual Acuity Testing as Community-Based Preschool Vision Screening at the Age of 3.5 Years in Japan

“…Visual acuity testing at school age is mainly aimed at detecting refractive errors, especially myopia, which is at a higher rate in Japan [ 20 ]. The vision-screening program in the earlier years of life is also intended to detect rare congenital diseases such as congenital cataract [ 21 ], ectopia lentis [ 22 ], ocular surface dermoid lesions [ 23 ], congenital ptosis [ 24 ], and congenital superior oblique muscle palsy [ 25 ]. These rare diseases are frequently associated with refractive errors that lead to the development of amblyopia.…”

Progressive large pediatric corneal limbal dermoid management with tissue glue-assisted monolayer amniotic membrane transplantation

“…In infants and children, the eyeball and the visual acuity are in the process of growth and development, and general anesthesia is required in pediatric eye surgeries. [10] Considering the tumor size, the tumor growth rate, and the involved areas, the appropriate time and techniques of surgical interventions are still controversy in infants and children. The proper treatment is particularly challenging in young children because of the tendency for a low visual acuity and astigmatism-related amblyopia.…”

Recurrent epibulbar dermoid cyst treated with amniotic membrane implant a case report

“…The AM has been used for the reconstruction of the conjunctiva and resulted in a good cosmetic outcome [ 18 , 19 ]. The AM has also been widely used in the reconstruction of corneal surface in several injuries such as neurotrophic ulcers [ 34 , 35 ], persistent epithelial defects, microbial keratitis [ 36 , 37 ], band keratopathy, bullous keratopathy [ 38 , 39 ] and chemical injuries [ 38 , 40 ]. Due to its properties, an AM implant was used in this 12-year-old patient with a recurrent dermoid cyst.…”

“…In the study reported by Matsuo, the clinical characteristics of superficial ocular dermoid cysts in paediatric patients [ 40 ] were evaluated in order to offer the best option for a clinical decision-making; either resection or observation of the cyst growth to determine the appropriate time for the excision. In this study we showed the efficacy and safety of the AM implant with MMC application to repair conjunctival defects after removal of the dermoid cyst.…”