What are they?
Many different benign lumps and bumps can occur on the eyelids and around the eyes. Benign (non cancerous) lid lesions usually do not interfere with the growth of the lashes or distort the smooth lid contour. A history of increasing growth, bleeding, ulceration, change in colour, and recurrence of the lesion after previous removal are features of importance that may suggest a malignant growth. When examined, a lid growth that is causing lash loss or disruption of the normal lash line or is distorting the natural smooth lid contour is suggestive of a malignant cancerous lesion.
Papillomas are the most common benign lesion of the eyelid. These growths represent a benign hyperplasia of the surface epithelium and may be sessile (flat) or pedunculated (on a stalk). They occur in middle aged and elderly individuals and may be solitary or multiple, occurring anywhere on the eyelid. Papillomas differ from the infective warts which consist of inflammatory hypertrophy of the surface epithelium. Treatment is by surgical excision.
Syringomas are benign, skin coloured papules 2-3 mm in diameter. They are usually located on the lower eyelids and cheeks but can be found on the upper lids. They mainly occur in women at any age after the mid teens. They involve the full thickness of the skin and so will recur if not completely excised.
Seborrhoeic keratosis is a common benign lesion on the lids of aging individuals.
They are well circumscribed, waxy, friable and appear stuck on to the skin. The lesion is very superficial and may be pigmented. Microscopically, they show hyperkeratosis and cystic areas filled with keratin. Treatment involves surgical excision.
Naevi are common in the eyelid area and may be pigmented or non-pigmented. The
naevus consists of a collection of benign appearing dermal melanocytes. Generally, they are present for years with no change. If the duration of any pigmented
lesion is unknown, acquired with age (especially after 40) or there is a change in size or colour, a biopsy is recommended.
Hordeola (Styes) and Chalazions
An external hordeolum (stye) results from an acute purulent inflammation of the superficial sweat glands, sebaceous glands or hair follicle of the eyelids, while an internal hordeolum occurs in the meibomian glands within the tarsal plates of the lids.
A chalazion is a chronic inflammation of a meibomian gland (deep type) or Zeiss sebaceous gland (superficial type) resulting in a clinically firm, painless nodule of the eyelid.
Treatment of the acute phase may involve hot compresses, antibiotics (drops, ointment, or tablets) while treatment of the chronic phase usually involves incision and drainage of the cyst.
Xanthalasma are superficial yellowish deposits commonly seen on the inner corner of the upper and lower lids. They represent collections of lipid material in the superficial dermis. Blood cholesterol and lipid levels should be checked as 30% of patients with xanthalasma will have an elevated lipid level that requires treatment. Xanthalasma can be treated by chemicals, surgical excision or laser, but approximately 30% of them will recur.
Epidermal Inclusion Cysts
These are small white-yellow cystic lesions occurring on the lid skin, conjunctiva, face or neck and are very common. They may develop spontaneously or arise following trauma or after surgery along an incision line. They originate from pilosebaceous follicles or implantation of surface epidermis. Some of these cysts occurring amongst the lashes will be difficult to distinguish from a blocked Zeiss gland (sebaceous gland). Treatment involves excision, and if the cyst wall is not removed, recurrence may occur.
Sebaceous cysts occur around the eyelid area and clinically resemble epidermal inclusion cysts. They are generally found in locations with many hair follicles, particularly the brow area and medial canthus. These cysts may occur secondary to obstruction of the Zeiss gland, meibomian gland or sebaceous glands associated with hair follicles of the lid skin or brow area. Unlike an epidermal inclusion cyst (filled with keratin material), a sebaceous cyst contains epithelial cells, keratin, fats and cholesterol crystals. Treatment involves surgical excision.
Milia are multiple well-delineated, round, yellow-white cystic lesions ranging from 1 to 3 mm in diameter, found on the face, lids, cheeks and nose. They may occur spontaneously or arise following trauma. They are felt to be retention follicular cysts caused by blockage of the fine pilosebaceous units (hair follicle). Surgical excision is the treatment of choice.
Retention Cysts, Cysts of Moll
The lid skin has numerous sweat glands (eccrine glands) and modified sweat glands (apocrine glands) such as the glands of Moll. Blockage of these glands leads to the formation of a translucent (water blister-like) lesion on the lid skin or lid margin amongst the lashes. They may occur as a single lesion or as several. Treatment involves total excision otherwise they will recur. Simply stabbing them with a needle is ineffective in allowing their resolution.