Squamous papilloma
⭐️ The most common benign tumour of the eyelid.
It is essentially a skin tag. They may be multiple and typically occur in middle-aged - older adults.
They have a typical papillary shape (shaped like a small mushroom with its stem attached to the epithelial lining) with a keratinised surface that is generally smooth.
They can be surgically excised with shave excision (if causing irritation or if cosmetically not acceptable) or they can be left alone.
Stye/external hordeolum
A hordeolum is an acute bacterial infection of the eye glands. A stye is caused due to an infection of the Zeis glands which are located near the eyelid margin at the base of the eyelashes. It can occur at either the upper or lower eyelid.
It appears red, swollen, tender and may have a pustule. It essentially looks like a pimple on the eye.
It can resolve spontaneously but sometimes needs topical antibiotics if there are signs of spreading infection such as conjunctivitis. Hot compress and analgesia is usually sufficient.
- Topical chloramphenicol can be applied 3-4 times daily with a single drop.
Naevus
An eyelid naevus is once again a well demarcated, pigmented tumour of the eyelid. It is slightly thickened and is dark as it is a melanocytic tumour.
It is benign and does not require treatment. However, a fast-growing naevus should be seen suspiciously as there is a risk that they can grow in malignant melanoma.
Molluscum contagiosum
It is a common skin infection caused by molluscum contagiosum virus (MCV). It is transmitted by personal contact and occurs mainly in children (1-4 years has highest incidence).
They are seen as pinkish/pearly-white papules sometimes with a central umbilication.
It is self-limiting and resolves spontaneously (within 18 months). However, lesions are contagious and towels and clothing should not be shared.
If there is associated red eye → urgent referral to ophthalmologist.
Epidermoid cyst/sebaceous cyst
An epidermoid cyst occurs due to a blocked sebaceous gland and is commonly seen around hair follicles. The hair follicle may be inflamed or infected and as a result topical antibiotics may be needed if this is the case.
It appears as a small, round bump underneath the skin.
Pinguecula and pterygium
- A pinguecula is a small, raised, white- or yellow-colored growth that is limited to the conjunctiva; it can occur on the inner or outer side of the eye. A pinguecula may contain deposits of protein, fat or calcium. For most people it does not affect vision, but in severe cases, it can interfere with the way the tears cover the eye, causing dryness, redness and inflammation.
- A pterygium, also known as surfer’s eye, is a raised, wedge-shaped growth of the conjunctiva that extends onto the cornea — the outer layer of the eye. These growths also can occur on either side of the eye. In some instances they remain small, but they can potentially grow to the point of feeling uncomfortable or affecting vision. Pterygia usually cause irritation, redness or a sensation of something in the eye, and sometimes cause decreased or distorted vision after changing the shape of the cornea.
Seborrhoiec keratosis
These are well demarcated, warty plaques that are slightly elevated usually. They have a “stuck-on” appearance and can have varying levels of pigmentation (pink → dark brown).
It is most common in >50 years old.
It can be removed using:
- Cryotherapy - liquid nitrogen or CO2 freezes the cells to death.
- Curettage - using a curette, the mass is isolated and can be excised.
- Laser ablation
Chalazion/internal hordeolum
This is a hordeolum affecting the Meibomian gland.
It may be painful and inflamed initially but self-resolves, leaving a non-tender lump, a retention cyst. It is generally found on the inner eyelid or on the eyelid itself as opposed to the margin of the eyelid.
🥇 Heat compression is the recommended.
It sometimes may require surgical drainage of the cyst but generally spontaneously resolves.
Xanthelasma
These are yellowish papules/plaques that develop due to localised deposition of lipids around the eyelid. They can also be seen in patients without lipid abnormalities.
They can be signs of:
- Familial hypercholestrolaemia
- Remnant hyperlipidaemia - another genetic condition (autosomal recessive) that leads to hypercholestrolaemia due to high IDL and chylomicron concentrations.
They don’t require treatment but they can be surgically excised or removed with laser therapy.
Hidrocystoma/cyst adenoma
These are cystic tumours of the sweat glands. They commonly occur due to blocked sweat glands in the eye, known as Moll’s glands. It is an apocrine sweat gland found on the margin of the eyelid, anterior to the Meibomian gland but posterior to the eyelashes and Zeis glands.
It is a clear, fluid-filled cyst. They resolve spontaneously or can be excised.
Dacryocystitis
Yet another cystic lesion due to blockage of the nasolacrimal gland. It is seen on the nasal aspect of the eye as a large mass.
It can be due to infection leading to acute dacryocystitis.
Symptoms may be:
- Eye pain
- Redness
- Swelling
It is most common in infants, adults >40 years, females and those with lacrimal sac tumours.
Topical/oral antibiotics may be prescribed. A blocked lacrimal system can be bypassed with a dacryocystorhinostomy to allow tears to drain into the nose and prevent recurrent infections.
