Dermolipoma of the orbit
Painless whitish swelling in the upper lateral quadrant of the right eyeball. Had been there for at least 4 years. No impairment of vision.
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Smoothly marginated mass adjacent to the superolateral right anterior eyeball, extending between the superior and lateral rectus muscles. Bright signal on T1 and T2 weighted images, no restricted diffusion and (except for a small, non-enhancing soft tissue nodule at the posterior end) complete signal loss on fatsat images. Minimal downward displacement of the right eyeball by the mass.
Dermolipoma is a congenital lesion closely related to limbic dermoid cyst of the eye. Both are choristomas, often covered by fine hairs on the surface. However, other than dermoid cysts, dermolipomas almost exclusively consist of mature fat tissue1. Detection is typically delayed until adulthood (median age of 22,5 years).
The lesion is rare and can be diagnosed clinically, therefore there is sparse imaging literature on the subject. Differentiation from dermoid cysts in younger patients, and subconjunctival fat prolapse in the elderly is important, for operative treatment of dermolipoma often entails severe complications. Total excision is contraindicated. Cautious debulking is the method of choice2.