Eye is surrounded by the Para-nasal sinuses. In children, the sinuses are small and they increase in size as the child grows. Children are vulnerable to sinus infections as a consequence of upper respiratory tract infections reducing the ciliary clearance from the sinuses and fluid stasis. Sinus infections in turn can be dangerous to the eyes as the distance between sinuses and eye is very small in children especially the medial walls of the orbits which is paper thin aptly named- lamina paprycea.
Once the incision wound had completely healed, it was like he never had a surgery. Even the patient himself couldn’t locate the scar. The is the benefit of a minimally invasive surgery and aesthetically planned surgery. Even though the entire orbital lobe of the lacrimal gland was excised, there was no dry eye in the patient. This is because most of the regular lacrimation is by minor lacrimal glands spread out throughout the conjunctiva (transparent layer on the eyeball).
Dermoid cyst (also known as choristoma) is a benign tumor growing out of a embryonic suture line. The tumour consists of normal cells occurring in an abnormal location. It is usually diagnosed in children when it is first visible but it is not uncommon to have adults coming to the clinic to know if it can be removed.
The MRI scan showed a large intraconal well defined mass sitting right next to the optic nerve causing mass effect which in turn was causing diminution of vision. My working differentials going into surgery- based on location and imaging was Cavernous Hemangioma, Fibrous Histiocytoma, Dermoid cyst, Schwannoma among others.