Orbital dermoid cyst presenting with hypertropia and defective depression: a rare presentation

INTRODUCTION: Intraconal dermoid cysts are a rare clinical entity. They are typically associated with symptoms such as proptosis, orbital pain, and diplopia. However, atypical presentations without these common features can occur, making diagnosis more challenging. METHODS: We describe a clinical case of a one-year-old child who presented with left hypertropia and restricted depression in the absence of proptosis or other clinical manifestations. High-resolution orbital and cranial magnetic resonance imaging (MRI) was performed. RESULTS: Orbital MRI revealed an intraconal lesion consistent with a dermoid cyst. Complete surgical excision of the cyst was performed. Histopathological findings confirmed the diagnosis of dermoid cyst. Excision resulted in resolution of hypertropia and improvement of ocular motility. DISCUSSION: This case highlights an unusual presentation of an orbital dermoid cyst. Despite their rarity, such cysts should be considered in the differential diagnosis of hypertropia, particularly when a restrictive pattern is observed without obvious external signs like proptosis.