Clinical decision upon resection or observation of ocular surface dermoid lesions with the visual axis unaffected in pediatric patients

Ocular surface or epibulbar dermoid lesions may present as limbal dermoids at the corneal limbus or dermolipomas in the conjunctival fornix. The purpose of this study is to review clinical features of ocular surface dermoids (grade I), with the visual axis unaffected, in pediatric patients, in order to find key features for making clinical decision, either resection or observation. The study involved 13 consecutive patients with limbal dermoids or fornix dermolipomas which did not affect the visual axis, seen in 11 years at a referral-based institution. Eight patients underwent surgical resection at the age, ranging from 1 to 18 (median, 4) years, with concurrent preauricular appendage resection in 3 patients. Limbal dermoids in 6 patients presented dome-shaped elevation from the ocular surface, and extended in inferotemporal quadrant for 1-2 clock hours. The remaining 2 patients showed dermolipomas in the temporal conjunctival fornix. Postoperative astigmatism at the final visit ranged from 0 to 7 (median, 2.9) diopters in 6 patients with limbal dermoids while ranged from 0 to 1 diopters in 2 patients with fornix dermolipomas. All patients with meaningful astigmatism wore glasses before and after the surgery, resulting in no apparent ametropic or anisometropic amblyopia. Observation was chosen in 5 patients with the age at initial visit, ranging from 0 to 2 (median, 1) years, and the age at the final visit, ranging from 2 to 6 (median, 3) years. Flat limbal dermoids, extending for 1-2 clock hours, were noted in 3 patients, a dome-shaped limbal dermoid for 1 clock hour in one, and a fornix dermolipoma in one. Three patients had preauricular appendages. No patient, except for one with a dome-shaped limbal dermoid, showed astigmatism, greater than one diopter. In conclusions, dome-shaped limbal dermoids were excised while flat limbal dermoids observed. The age at surgery varied largely in pediatric patients with limbal dermoids (grade I) or fornix dermolipomas which did not affect the visual axis. The surgical timing was influenced by surgical scheduling for preauricular appendage resection, determined by a plastic surgeon. Surgical decision was made for cosmetic purposes, but not for medical needs to avoid amblyopia.