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Photo Essay
October 2001

Eye-Tooth: A Case of Orbital Dentigerous Cyst After Trauma

Arch Ophthalmol. 2001;119(10):1560-1561. doi:10.1001/archopht.119.10.1560

DENTIGEROUS cysts surrounding the crown of unerupted teeth are formed by cystic changes in the dental follicle after completion of enamel formation. They are twice as common in men and typically appear between the ages of 20 and 50 years.

A healthy 65-year-old Caribbean man had a slowly progressive, painless swelling of the right lower eyelid since receiving blunt trauma to the cheek 18 months earlier. Ocular motility and vision were unchanged and he had only occasional watering of the eye. Visual acuity was 20/20 OU with no relative afferent pupillary defect, and ocular ductions were full. A 2-cm-diameter soft fluctuant mass was located just behind the inferonasal orbital rim (Figure 1A). The right upper canaliculus was stenotic but irrigation with isotonic sodium chloride solution flowed through the lower canaliculus to the nose. The clinical differential diagnosis was either a large diverticulum of the lacrimal sac or a mucocele of the maxillary sinus expanding into the orbit through the nasolacrimal duct.

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