Year : 1981 | Volume
: 29 | Issue : 2 | Page : 69--73
Clinical evaluation and surgical intervention of limbal dermoid
Madan Mohan, G Mukherjee, Anita Panda
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S. Ansari Nagar, New Delhi, India
Chief Organiser and Prof. of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi
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Mohan M, Mukherjee G, Panda A. Clinical evaluation and surgical intervention of limbal dermoid.Indian J Ophthalmol 1981;29:69-73
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Mohan M, Mukherjee G, Panda A. Clinical evaluation and surgical intervention of limbal dermoid. Indian J Ophthalmol [serial online] 1981 [cited 2021 Jun 13 ];29:69-73
Available from: https://www.ijo.in/text.asp?1981/29/2/69/30966
Dermoid tumors of the limbus remain localised mostly to the superficial layers of the cornea and sclera, are fairly common congenital anomaly of the eye. The hereditary and genetic nature of this tumour is disputable . It has been postulated that physiochemical factors including that of hormones can be a predisposing factor of such a congenital anomaly .
The objective of this study is to report a series of cases, to stress the peculiarities in presentation and to evaluate different modes of management.
MATERIALS AND METHODS
Twenty five cases of limbal dermoid, over a period of 4 years, were analysed for the age of onset of the disease, rate of growth, effect of onset of puberty on the growth of tumour and the complete family history. Thorough systemic examination of each case was carried out to detect any associated anomaly. The Slitlamp examination was done to determine the site, size, surface and depth of the corneal involvement. The extent of the lesion was represented on a topographic chart [Figure 1]. Gonioscopy was done in each case to determine the depth of the stromal involvement and its effect on the angle of anterior chamber. These cases were managed with different type of procedures [Table 2]
Age, sex distribution and laterality of these cases are shown in [Figure 2]. Only one case had positive family history with autosomal dominant mode of transmission [Figure 3]. The site of involvement of limbal dermoid in various segments are shown in [Figure 4]. Two cases had bilateral involvement with asymmetry in the site and size [Figure 5] of lesion.
Majority of these cases had poor visual acuity due to irregular astigmatism and only few had gross loss of vision due to central corneal involvement [Table 1]. Two of our cases had involvement of angle of anterior chamber in the form of peripheral anterior synechiae as detected by gonioscopy. Seven cases had accessory auricles on both sides. Amongst these seven cases two had associated lid colobomas. One case had only lid coloboma, without accessory auricle. Two cases of Goldenhar Syndrome with Vertebral changes were included in this series.
The details of Management are described in [Table 2]. None of theses had recurrence in a follow up of 6 months to 4 years.
A dermoid is described as a solid congenital tumour consisting of mesoblastic tissue covered by ectoderm and invaded by ectodermal derivatives. The most frequent site of involvement is believed to be lower temporal segment.
Usually the tumour is unilateral but a few bilateral sporadic cases are also reported. The bilateral involvements are always symtrical which was not true in our cases [Figure 5]. The association of auricular appandages, lid Coloboma, vertebral changes etc, are well known. Limbal dermoid, as reported, do not occur in families, thus are not hereditary predisposed. However, very little importance have been laid on its familial predisposition except by Baum & Murray. One of our case had positive family history with autosomal dominant mode of transmission.
Corneal topography chart and meticulous gonioscopic examination of each eye helped us in noting the extent and depth of lesion. Posterior corneal protrusion, synachiae or pigmentation, as detected by gonioscopy, made follow up easy as well as proper planning of surgery.
All our cases had limbal dermoid since birth except one, and this is no exception to common belief. Though few authors have reported nasal and central appearance of limbal dermoid, but in our series 77.8% were seen on the temporal and lower temparal segments of eyes. Various earlier reports on the limbal dermoid are summarized,,,,,, [Table 3].
The auricular appendages and verte-bral changes occured as a primary lesion, as a part of the syndrome, but the occurence of lid coloboma could be both primary or secondary.
Baum and Murrary & Thomas were of the view that if the dermoids involve the posterior half of the stroma then the semi opaque area should be left as such or an incomplete removal to be done rather than to enter the anterior chamber. Simple excision and excision with keratectomy are recommended only in cases where the dermoids were under 5mm size and involve the superficial stroma only. In view of the occurence of pseudopterygium in one case operated for limbal dermoid, we recommend a deep lamellar keratoplasty in such cases.
In the present series, perhaps the largest series in the literature, in 10 cases the size of the dermoid was over 5mm., and deeper layers of the cornea had been affected. Most patients in this group were girls of marriageable age and were brought for cosmetic relief. Once the deeper layers are involved, the extent increases towards the optical zone, the posterior corneal dome protruded posteriorly or the angle of the anterior chamber shows some anomaly, then the functional and cosmetic relief is only possible by a deep L.K. and may even end up in accidental penetrating keratoplasty. It is, therefore, essential that fresh cornea should be at hand while planning a deep L.K in such cases.
The criteria for surgery is (i) cosmetic excision. It should be undertaken early when a simple excision or excision with superficial keratectomy will suffice.
(ii) When the lesion becomes progressive and starts to increase in size or cause irritative symptoms. (iii) When it threatens to affect or has affected vision due to astigmatism. Earlier the surgery is undertaken the simpler is the procedure and better are the overall results.
A series of twenty seven eyes of twenty five ceses of limbal dermoid are presented with their surgical management.
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