In many instances, limbal dermoids can be managed conservatively with topical lubrication and occasional epilation.

Surgical excision may be considered in cases of:

The potential benefits of surgery must be carefully weighed against potential surgical complications and scar formation. The family should be included in medical decision-making via the informed consent process.

A thorough medical and family history is necessary with referral to a pediatrician who specializes in genetics if the dermoid is thought to be syndromic in nature.

If a limbal dermoid appears to only involve superficial structures, B-scan ultrasonography can be performed to confirm.

If the lesion appears to extend into the lateral canthus or into the conjunctival fornix, MRI imaging may be necessary. It is not uncommon for these deep lesions to be interconnected with orbital fat and connective tissue adjacent to extraocular muscles, necessitating an orbital surgeon for the excision.

Mark the border of the dermoid with a fine marking pen.

In the subconjunctival space peripheral to the lesion, inject ˜0.1 cc of preservativefree lidocaine 0.75% with epinephrine.

Using Westcott scissors, perform a conjunctival peritomy along the border of the lesion.