Conjunctival dermoid cyst seen on examination as a chronically red eye

We describe a patient who was seen with a unilateral red eye and purulent discharge refractory to antibiotic treatment with multiple antibiotic regimens over the previous 4 months. Initially it was believed to be a bacterial conjunctivitis, but when conventional treatments failed it was thought to be a viral conjunctivitis with bacterial superinfection. Cultures yielded only Enterococcus. There was a small mass with a draining fistulous tract at the lateral canthus. Symptoms persisted despite courses of topical and systemic antibiotics followed by a tapering dose of steroids. The patient was taken to the operating room for an orbitotomy through the conjunctiva at the lateral canthus. Findings from pathologic examination of the excised mass demonstrated a dermoid cyst of the conjunctiva. This clinical appearance obscured the diagnosis.