Conjunctival dermoid cyst seen on examination as a chronically red eye

Area of Science:

• Ophthalmology
• Dermatology
• Pathology

Background:

• Persistent unilateral red eye and purulent discharge can mimic infectious etiologies like bacterial or viral conjunctivitis.
• Refractory symptoms despite multiple antibiotic regimens and steroid treatment prompted further investigation.

Observation:

• A small mass with a draining fistulous tract was noted at the lateral canthus.
• Cultures revealed only Enterococcus, which is a common commensal organism.

Findings:

• Surgical excision via orbitotomy revealed a dermoid cyst of the conjunctiva.
• Pathologic examination confirmed the diagnosis of a benign choristoma.

Implications:

• Conjunctival dermoid cysts can present with atypical symptoms, mimicking chronic infections.
• Early recognition and surgical management are crucial for resolving refractory ocular symptoms.
• This case highlights the importance of considering rare diagnoses in challenging clinical presentations.