Chronic, traumatic intraconal hematic cyst of the orbit removed through the fronto-orbital approach - Case report

Abstract

A 22-year-old male presented with a chronic encapsulated intraorbital hematoma 3 months after blunt trauma to his left eyeball. Ophthalmological examination found the best corrected visual acuity was 4/20 in the left eye, and 20/20 in the right eye. The orbit exhibited exophthalmus and inability of the eye to move above the horizontal level. Orbital magnetic resonance imaging showed a fairly well-demarcated area in the medial aspect of the orbit appearing as hyperintense on T1-weighted images and isoto hyperintense on T2-weighted images. This area was believed to be hemorrhage. No other abnormalities were found. The diagnosis was hematic cyst. The cyst was approached through a left fronto-orbital route and its location identified within the periorbita and orbital fat. The cyst was removed partially. Histological examination demonstrated cystic accumulation of blood and breakdown products in a non-epithelium-lined fibrous capsule, compatible with hematic cyst. The presence of hemosiderin in the cyst wall suggested that the cyst was a chronically enlarging lesion. Hematic cysts of the orbit usually present as subperiosteal mass months to years after trauma. Surgical removal of the cyst wall rather than needle aspiration is recommended to prevent recurrence.