Limbal Dermoid

A 12-year-old boy presented to us with history of swelling in his right eye since birth and difficulty in vision for the last 2-3 years. The swelling was soft, localised, elevated, opaque, yellow-white mass located on the inferior temporal limbus at 7-8’o clock, there were fine hair present on the surface of swelling. Cycloplegic auto-refraction of the patient showed SPH +3.25 with CYL +5.00 at 118 degrees in right eye and SPH +1.25 with CYL +2.50 at 91 degrees. The patient had significant astigmatism in his right eye. Rest of the clinical examination of the patient was normal including anterior segment examination and retinal examination. The diagnosis of Limbal Dermoid was subsequently made and patient was advised excision.

Limbal dermoids are benign tumors that are choristomas (normal tissue at an abnormal site). Dermoid contains hair, adipose tissue, and squamous epithelium, presence of these findings is almost always pathognomic. Limbal dermoids are usually not inherited, however familial presentation of limbal dermoids in association with systemic disorders, such as Goldenhar syndrome is well known. Other associated ocular abnormalities include colobomata of the eyelids, lacrimal anomalies, scleral and corneal staphylomata, aniridia, and microphthalmia. Limbal dermoids can cause cosmetic disfigurement along with pressure symptoms on cornea leading to astigmatism and amblyopia in younger children. Prognosis generally is favorable and diagnosis is clinical.

The treatment approach for limbal dermoids may involve various methods depending on the specific case. These can include regular removal of irritating cilia, using topical lubrication to prevent foreign body sensation, or opting for surgical excision if the dermoid causes significant cosmetic disfigurement or vision interference.

Surgical intervention should be considered when the potential benefits, such as improved vision or cosmetic appearance, outweigh the risks associated with scar formation or surgical complications. The decision to proceed with surgery should be carefully evaluated, taking into account the individual patient's needs and circumstances.

Limbal Dermoid in a 12 years old patient, note the fine hairs on the surface and surface keratinization.