Solid dermoids of the limbus and the cornea.

PURPOSE

To better define the spectrum of limbal and corneal dermoid characteristics and to obtain data on the visual outcome following surgery.

METHODS

We reviewed the ocular records of 12 consecutive patients with solid dermoids which underwent surgery in our institution from 1985 to 1993. According to tumor size and location, limbal dermoids can be managed with a simple excision associated with a conjunctival flap or corneoscleral lamellar keratoplasty.

RESULTS

Surgical techniques, cosmetic and visual outcomes are documented. Limbal dermoids were more noticeable cosmetically, and they often induced oblique astigmatism. In 6 cases, they could easily be shaved off the cornea and adjacent sclera to improve the appearance of the eye; visual acuity was unchanged. In 3 cases, unfortunately a degree of refractive amblyopia remained after late surgery and visual acuity was inferior to 20/200. In 2 large-diameter limbal dermoids, early corneolamellar keratoplasty allowed to improve best corrected visual acuity. In the corneal dermoid, amblyopia was the indication for early surgical removal.

CONCLUSION

We believe that early surgery with simple local resection (combined with a conjunctival flap in order to cover the bare area) may be preferred to lamellar keratoplasty. Nevertheless, corneoscleral lamellar grafts may be required in advanced cases, especially when the whole thickness of the corneal stroma is involved or when the tumor deeply extends around the limbus.