Three Adult Cases of Orbital Hidrocystoma Presenting with Blepharoptosis

Abstract

Purpose: To report adult cases of superior orbital apocrine hidrocystoma. Methods: Retrospective case series of three patients with superior orbital apocrine hidrocystoma and blepharoptosis with review of the clinical aspects of each of the cases. Results: All three cases presented with blepharoptosis. Two of the cases had occult hidrocystoma, and one was visibly subcutaneous at presentation. Conclusions: Although rare and more common along the eyelid margin, apocrine hidrocystomas may occur in the orbit leading to secondary blepharoptosis and should be included within the differential diagnosis of orbital cysts. Physicians should therefore be aware of this possibility.

Orbital apocrine hidrocystoma with immunohistochemical confirmation

“…It has been hypothesized that sequestration of epithelial cells at the embryonic stage or traumatic implantation of epithelial cells into deeper tissues, including orbit, could lead to the condition. In our case, the lesion was acquired and there was no history of trauma or any prior surgical procedures (3)(4)(5)(6)(7)(8) .…”

“…Apocrine hidrocystomas are benign cystic lesions derived from the sweat glands of Moll and seldom found in the orbit. In this case, we report an apocrine hidrocystoma found in the superomedial wall of the orbit (1)(2)(3)(4) . Although orbital cystic lesions are often encountered, they are mostly dermoid cysts and mucoceles.…”

“…They are usually yellow-to-white (sometimes with layering) but less commonly blue to black (due to the Tyndall effect from the turbid contents), typically arise at the eyelid margins particularly around the inner canthus of the eyelid where the glands of Moll are located. Apocrine hidrocystomas are seldom found in the orbit (2)(3)(4)(5)(6) . The pathophysiology of hidrocystomas is uncertain.…”

Primary orbital apocrine hidrocystoma with sebaceous elements

“…The majority of orbital hidrocystomas are congenital, and reported in the paediatric population. In adult cases, traumatic implantation of epithelial cells may be implicated, but most of the few reported cases are idiopathic …”

“…Typically, orbital apocrine hidrocystomas are slow‐growing, with symptoms related to mass effect reported over months to years . Most lesions are located in the anterior orbit, although one report described a mid‐orbital location …”