Ruptured Orbital Dermoid Cyst Masked as a Migraine in a 25-Year-Old Male

Dermoid cysts are a variation of teratoma made up of ectoderm and mesoderm and represent a large proportion of scalp and skull masses found in children. Orbital dermoid cysts are an exceedingly rare form of primary orbital tumors. We present a case of a 25-year-old active duty male presenting with new onset migraines, eye pain on waking, and intermittent blurred vision. According to current clinical practice guidelines, intracranial imaging was obtained, which revealed an orbital mass. The mass was successfully excised, and surgical pathology confirmed the diagnosis of an orbital dermoid cyst. We examine this clinical presentation as a way to reinforce primary care clinical practice guidelines. Orbital dermoid cysts are a rare diagnosis, especially in the primary care setting and typically present with symptoms that are often quite subtle. This case serves as an example to primary care providers and other physicians to have a low threshold for intracranial imaging in new-onset headaches or a change in the pattern of chronic headaches.