Purpose

To report a case of a scleral epithelial cyst presenting with globe displacement and frontal bone compression.

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Methods

Scleral epithelial cysts are rare benign lesions typically reported following ocular surgery or trauma, and orbital presentations without such history are uncommon.
A 65-year-old man presented with progressive swelling of the left upper eyelid that began in April 2023. The lesion had initially been treated with repeated aspiration at another institution but gradually enlarged over time. The patient had no history of ocular surgery or orbital trauma. Magnetic resonance imaging demonstrated a well-defined superior orbital mass with homogeneous internal signal intensity, suggesting a cystic lesion. The mass displaced the globe inferiorly and compressed the frontal bone, raising suspicion for a cystic orbital tumor possibly related to the scleral region.
Surgical excision was performed through a transverse skin incision directly over the tumor. During dissection, partial rupture of the cyst occurred. The cyst wall was carefully dissected and completely removed. No direct continuity with the sclera was identified intraoperatively.

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Results

Histopathological examination revealed a cyst lined by non-keratinized stratified squamous epithelium without dermal appendages, consistent with a scleral epithelial cyst. Several months later, the patient underwent a second procedure consisting of scar revision and eyebrow skin excision to remove residual scar tissue and redundant skin. At six months after the second surgery, the patient remains free of recurrence.

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Conclusion

This case illustrates that scleral epithelial cysts may present as orbital cystic lesions with significant mass effect, including globe displacement and bony compression, even in the absence of prior ocular surgery.

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Additional Authors

First name	Last name	Base Hospital / Institution
Ryo	Kikuchi	Oculoplastic Clinic Chiba
Tomoyuki	Kashima	Oculo Facial Clinic Tokyo

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