Peri-orbital Dermoid Cyst

A dermoid cyst forms before birth when a small pocket of skin cells becomes trapped beneath the surface as the tissues of the face fuse together. Over time the trapped cells produce skin oils and debris, and the cyst slowly grows.

The most common site is beside the outer end of the eyebrow, where it appears as a smooth, firm, rounded lump under normal-looking skin. It is usually painless and fixed to the bone beneath. Parents often notice it in the first months of life or as their child's face grows. Peri-orbital dermoid cysts are benign and do not affect the eye or vision.

• Dermoid cysts do not resolve on their own and gradually enlarge as your child grows. Removal is recommended because the cyst may:
• Become more noticeable as it grows
• Rupture after a bump, causing sudden inflammation and a longer-lasting reaction in the surrounding tissue
• Occasionally become infectedRemoving it while it is small and intact makes the operation simpler and the scar shorter. The diagnosis is usually clear on examination, and imaging is only occasionally needed. Surgery is planned electively at a time that suits your family, often in the first few years of life.

The cyst is removed under a general anaesthetic as day surgery. Local anaesthetic is also used to keep your child comfortable afterwards.

A short incision is made directly over the cyst or, where possible, hidden within the eyebrow or in the eyelid crease so that the scar is disguised. The cyst is gently freed from the surrounding tissue and from the shallow hollow it often makes in the bone, and is removed whole. The skin is closed with fine dissolving stitches and skin glue or a small dressing. The tissue is sent to the laboratory to confirm the diagnosis.

Discomfort is mild and simple pain relief is usually enough. Some swelling and bruising around the eyebrow and upper eyelid is common in the first few days and may make the eye look a little puffy before it settles.

Keep the wound dry for a couple of days, after which gentle washing is fine. Avoid rough play and contact sport for around two weeks. The scar softens and fades over many months, and protecting it from the sun helps. Contact the team if there is increasing redness, discharge or fever. The wound and laboratory result are reviewed at a follow-up appointment.