Eur J Plast Surg (1999) 22:139±141
G.F. Maillard ´ F. Brachmanski ´ C. Duc ´ N. Ducrey
Chronic orbital hematic cyst
Received: 10 July 1998 / Accepted: 28 October 1998
G.F. Maillard (
Avenue de la Dôle 17, CH-1005 Lausanne, Switzerland
Tel. +41-21-323-6666; Fax +41-21-323-6610
F. Brachmanski ´ C. Duc
Institut Central des Hôpitaux Valaisans, Lausanne, Switzerland
N. Ducrey ´ S. Uffer
Department of Ophthalmology, Hôpital Ophtalmologique Lausanne,
Abstract A rare case of chronic orbital hematic cyst is
reported. A 40-year-old male presented with a mass
which displaced the eye downward. The initial symptoms,
progression of the disease, the difficulty in clinical and ra-
diological diagnosis are presented and discussed together
Key words Chronic orbital hematic cyst ´ Orbital tumor
Chronic orbital hematic cysts are rare entities. A percent-
age cannot be reported from the available literature. Some
of these hematic cysts are related to previous trauma to
the orbit. A recent paper  reported a significant orbital
hematic cysts which invaded the orbital roof and necessi-
tated a craniofacial correction.
The difficulty in this case was also shown by the MRI
reports: twice the radiologist believed it was a lymphangi-
oma but without totally excluding the possibility of a
ªthrombosed varicose formationº.
The patient, a 40-year-old male, was born in 1957. He had strabis-
mus of the left eye and was operated on by an experienced ophthal-
mologist in August 1996. No mention of foreign body is mentioned
in the operation report. The patient had no previous accidents or oth-
er damage to his left orbit.
Six months later he presented with a mass displacing the left eye
downwards. The initial MRI scan was reported as a ªlymphangio-
maº but ªsome hypersignals may correspond with hemosiderin de-
positsº. The differential diagnosis was a thrombosed varicose forma-
tion, an old intratumoral hemorrhage (chocolate cyst) or an ªorbital
hematomaº of ªspontaneous originº.
The patient was followed for approximately one year and he then
consulted the first author with a significant downward displacement
of the left eye (Fig. 1). An MRI produced the diagnosis of lymphan-
A transverse incision was made in the superior orbitopalpebral fold,
and the orbital septum was divided. The levator palpebrae and the
globe were pushed downwards by a large mass. Using 4 loupes
the mass was carefully dissected. The mass was fixed to the lacrimal
gland, and initially it was thought to originate from the gland.
The roof of the orbit was eroded over 4±5 mm by the ªtumorº
(Fig. 3). It was surrounded by a thick capsule, under the orbital roof
the capsule was less thick and here it ruptured during the dissection.
The contents were black and yellow. The resection was completed,
the orbit was carefully examined, and there was no intracranial in-
volvement. All orbital irregularities were contoured with a drill to
provide smooth bone surfaces.
The ªupper eyelid fat padº was transposed onto the orbital cavity
as a filler. The orbital septum was loosely sutured as was the skin,
and three silicone mini-drains were placed in the wound. A Frosch
suture was placed in the upper lid to pull it downwards in order to
avoid a spasm of the levator palpebrae.
The three silicone drains were removed after 24 h. There was no
hematoma or bruising. At six months after surgery the patient was
free of any complication, and the patient recovered uneventfully
Two fragments of brownish friable and hemorrhagic tissue measur-
ing 0.52.5 cm.
The microscopic pattern showed fibrous and vascular tissue sur-
rounding nodular collections of foamy macrophages. A foreign body
reaction was observed with cholesterol crystals. In addition, there
were many hemosiderin deposits and an undetermined birefringent
amorphous material (Fig. 4). These patterns are suggestive of an or-