Vol. 7, Issue 1, Part B (2025)

Background: Epibulbar dermoid are congenital benign tumors categorized as choristomas, comprising ectopic tissue of ectodermal and mesodermal origin. They typically present during childhood and are frequently discovered incidentally during routine eye examination. Adult presentations are uncommon and, therefore, pose unique diagnostic and management challenges. These lesions, though benign, may mimic other ocular surface masses, thereby requiring careful evaluation.

Case Presentation: We present a case of a 37-year-old male with a gradually progressive, painless mass over the left eyeball of three years' duration. Clinical evaluation revealed a firm, pinkish subconjunctival lesion measuring 1.5 × 2 cm in the inferotemporal quadrant, hair-bearing, smooth, and adherent to the sclera. Visual acuity was preserved (6/6 in both eyes), and there was no corneal involvement or motility restriction. The differential diagnosis included dermolipoma, conjunctival cyst, granuloma, and atypical pterygium. CT imaging excluded intraocular or intraorbital extension. The lesion was surgically excised under local anesthesia; a specimen measuring 1 × 0.9 cm was obtained and sent for histopathological confirmation. Postoperatively, the patient maintained full vision and ocular motility, with mild subconjunctival hemorrhage noted. The patient was followed up with satisfactory cosmetic outcome and absence of recurrence.

Conclusion: Adult-onset epibulbar dermoids are rare and demand a high index of suspicion for diagnosis. Imaging, coupled with histopathological evaluation, ensures accurate confirmation. Surgical excision remains the treatment of choice for symptomatic or cosmetically significant lesions. This case underscores the importance of early identification and surgical management of epibulbar dermoids to preserve vision and achieve favorable outcomes.