Common Eyelid Lesions

The eyelids contain skin, muscle, glands, and connective tissue -- each of which can give rise to various benign lesions. Understanding the most common types helps distinguish harmless lumps from those requiring further investigation.

Chalazion

A chalazion is a chronic, non-infectious granulomatous inflammation of a meibomian gland. When the gland duct becomes blocked, lipid secretions accumulate and trigger a local inflammatory response. The result is a firm, round, typically painless nodule within the eyelid.

Chalazia are the most common reason patients seek oculoplastic evaluation for an eyelid lump. They can occur on the upper or lower lid and may distort vision if large enough to press on the cornea.

Conservative management

• Warm compresses applied for 10-15 minutes, two to four times daily
• Gentle lid massage to express the blocked gland contents
• Lid hygiene with diluted baby shampoo or commercial lid wipes

Surgical treatment (incision and curettage)

When a chalazion does not resolve with conservative measures after four to six weeks, a minor procedure is performed. The eyelid is everted, a small incision is made on the inner (conjunctival) surface, and the granulomatous material is curetted. No external scar results. The procedure is done under local anesthesia.

Eyelid Cysts

Epidermal inclusion cyst

A firm, round, subcutaneous nodule formed by trapped keratin within a lined epithelial sac. It grows slowly and is painless unless it becomes infected.

Cyst of Moll (apocrine hidrocystoma)

A translucent, fluid-filled cyst arising from the glands of Moll near the lid margin. Simple excision or puncture is curative.

Cyst of Zeis

Originates from the sebaceous glands of Zeis associated with the eyelash follicle. Usually small and located at the lid margin.

Papillomas and Skin Tags

Squamous papillomas are pedunculated or sessile, skin-colored or pigmented growths that arise from the eyelid epidermis. They are benign but may be removed for functional reasons (if they obstruct the visual axis) or cosmetic preference.

Xanthelasma

Yellowish, flat or slightly raised plaques in the medial eyelid skin caused by lipid-laden macrophage deposits. They are associated with hyperlipidemia in some patients. Removal options include surgical excision, trichloroacetic acid peel, or laser ablation. Recurrence is relatively common.

Milia

Tiny, white, superficial keratin cysts just beneath the epidermis. They are harmless and can be treated with simple needle extraction if desired.

Diagnosis

Most eyelid lesions are diagnosed on clinical examination based on their appearance, consistency, location, and history. When malignancy cannot be excluded by clinical features alone, a biopsy is performed. A lesion that recurs in the same location despite drainage or excision warrants histopathological examination to rule out sebaceous gland carcinoma or other malignancies.

Recovery After Excision