Purpose

This report describes a rare case of large disfiguring orbital eccrine hidrocystoma in an infant’s eye.

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Methods

Case report

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Results

A 6-month-old term infant was brought by parents with history of disfiguring eyelid swelling over the right eye (RE) since birth and gradually increasing in size. On examination, a rounded cystic mass was seen over the lateral aspect of the RE, involving upper and lower eyelid, measuring 2cm x 2cm with soft consistency. The mass was covering the visual axis. Transillumination test was positive over the mass. Anterior chamber examinations of bilateral eyes were unremarkable, with clear cornea. Fundus examinations revealed pink optic disc with cup-disc ratio of 0.4 and flat retina. Computed tomography (CT) scan of the orbits showed lateral hypodense mass over the right orbit, likely due to complex or proteinaceous contents causing mass effect to the right globe, in favor of a congenital orbital cystic lesion. Right eyelid and orbital mass excision with symblepharon ring placement was done subsequently and the cystic specimen was sent for histopathological examination (HPE). HPE revealed a cyst composed of thin fibrous wall lined by a dual layer of benign cuboidal epithelial cells, containing clear watery fluid. The findings are consistent with eccrine hidrocystoma. Postoperatively, steroid and antibiotic oilments was given over the right eye and he recovered well with no sign of recurrence.

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Conclusion

Orbital eccrine hidrocystoma is a rare benign cystic lesion that may present as congenital eyelid swelling and mimic other orbital masses, especially lacrimal ductal cyst which require marsupialization. Imaging and clinical examinations are helpful in differentiation. Complete surgical excision remains the mainstay of treatment and is associated with excellent functional and cosmetic outcomes.

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Additional Authors

First name	Last name	Base Hospital / Institution
Rongkai	Tan	Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.

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