Orbital dermoid cyst presenting with hypertropia and defective depression: a rare presentation

Intraconal dermoid cysts are a rare clinical entity. They are typically associated with symptoms such as proptosis, orbital pain, and diplopia. However, atypical presentations without these common features can occur, making diagnosis more challenging.

We describe a clinical case of a one-year-old child who presented with left hypertropia and restricted depression in the absence of proptosis or other clinical manifestations. High-resolution orbital and cranial magnetic resonance imaging (MRI) was performed.

Orbital MRI revealed an intraconal lesion consistent with a dermoid cyst. Complete surgical excision of the cyst was performed. Histopathological findings confirmed the diagnosis of dermoid cyst. Excision resulted in resolution of hypertropia and improvement of ocular motility.

This case highlights an unusual presentation of an orbital dermoid cyst. Despite their rarity, such cysts should be considered in the differential diagnosis of hypertropia, particularly when a restrictive pattern is observed without obvious external signs like proptosis.