Respiratory Epithelial Orbital Cyst: A Case Report and Literature Review

Abstract

A 44-year-old male with schizophrenia presented with progressive right proptosis for one year and conjunctivitis for two months. An orbital cyst was seen in the superotemporal region on computerized tomography and was surgically removed. There was no history or radiological signs of paranasal sinus disease or previous trauma. Histopathologic evaluation revealed a cyst lined with respiratory epithelium. Respiratory choristomatous cysts of the orbit are considered rare in both pediatric and adult patients. We review the literature of respiratory orbital cysts and conclude that they tend to present in adults and should be considered in the differential diagnoses of orbital cysts.

Primary Orbital Respiratory Epithelial Cyst: A Systematic Review and Two Case Reports

“…The right orbit was affected in 12 cases, and 11 of 18 cases were women. The superotemporal quadrant was involved in 4 cases, [1][2][3][4][5][6][7][8][9][10]17 the temporal quadrant in 3 cases, [3][4][5][6][7][8][9]17 the medial quadrant in 6 cases, [2][3][4][5][6][7][8][9][10]14,17 intraconic lesions in 3 cases, 12,13 infraorbital and upper eyelid in 2 cases each. 15,16 Reviewing the literature, the primary respiratory epithelial cyst most commonly occurred with mild proptosis, periorbital or eyelid swelling, restricted ocular motility, and deteriorating vision in 2 cases with orbital apex syndrome.…”

“…In reviewing the literature all cases underwent surgical excision; rupture of the wall was reported in 7 cases and watery fluid was evacuated. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] In 2 of 7 cases the capsule was marsupialized to reduce the risk of recurrence. 12,13 No details of surgical approach were described in 6 cases.…”

Cystic Lesions of the Orbit

“…[144][145][146] Congenital cases occur in the absence of sinus disease or trauma, are commonly found within the superotemporal quadrant, and follow a characteristically gradual course. 147,148 Posttraumatic cysts arise from the proliferation of epithelial tissue displaced through a fractured or otherwise compromised orbital wall and, unlike mucoceles, are confined to the orbital cavity. 144,147 There is often a history of surgical fracture repair with placement of an implant up to several decades before the presentation.…”

“…Primary orbital respiratory epithelial cysts can arise following trauma or, rarely, through sequestration of respiratory epithelium during embryological development of the paranasal sinuses 144–146 . Congenital cases occur in the absence of sinus disease or trauma, are commonly found within the superotemporal quadrant, and follow a characteristically gradual course 147,148 . Posttraumatic cysts arise from the proliferation of epithelial tissue displaced through a fractured or otherwise compromised orbital wall and, unlike mucoceles, are confined to the orbital cavity 144,147 .…”

“…147,148 Posttraumatic cysts arise from the proliferation of epithelial tissue displaced through a fractured or otherwise compromised orbital wall and, unlike mucoceles, are confined to the orbital cavity. 144,147 There is often a history of surgical fracture repair with placement of an implant up to several decades before the presentation. 144 Such cases have occurred with various implant materials, including 144 Common presenting features include proptosis, globe displacement, and diplopia; posttraumatic cysts can present with acute infection.…”