Epidermoid cyst masquerading as dacryocystocele: case report and review

A 21-month-old boy presented with a medial canthal mass since birth that was clinically consistent with a dermoid or epidermoid cyst. Computed tomography and neuroradiologic interpretation questioned the clinical diagnosis- as the lesion was radiographically consistent with a dacryocystocele. Excision via anterior medial orbitotomy revealed an epidermoid cyst. Lacrimal irrigation was normal at the time of surgery. Diagnosis of orbital lesions in the region of the lacrimal sac can be confounded by radiographic imaging. This case demonstrates the importance of clinical evaluation in differentiating benign congenital orbital tumors in the peri-lacrimal region, from frank lacrimal pathology.