Eyelid Lumps

THE EYELID IS A COMPLEX STRUCTURE WHICH CONTAINS MANY DIFFERENT TISSUE COMPONENTS, EACH OF WHICH CAN GIVE RISE TO A DIFFERENT TYPE OF EYELID LUMP.

The most common type of eyelid lump is the Chalazion, which is a cyst of one of the oil producing glands of the eyelid. These can be removed in the clinic easily and under local anaesthetic, with a hidden incision on the inside of the upper eyelid.

A variety of other benign lumps and bumps such as sweat gland cysts, sebaceous cysts and warty growths are also common on the eyelid and can be removed simply and safely. These are also carried out under local anaesthesia.

Xanthelasma is another common benign eyelid lesion which appears as a pale discolouration which is caused by cholesterol deposition on the inner parts of the upper and lower eyelids. This can also readily be removed.

The eyelid is also a very common site for malignant tumours such as basal cell carcinoma (BCC) and other forms of skin cancer. Basal cell carcinoma presents as a painless hard lump, most commonly on the lower eyelid, which grows slowly to invade and destroy deeper tissues. It is essential that these are removed as early as possible. The key principles of management for malignant eyelid lesions are complete surgical removal, followed by reconstruction.

Chalazion

This is a common eyelid condition which occurs as a result of inflammation induced by blockage of the oil glands in the eyelids (Meibomian gland). The oil secreted by these glands is essential in the maintenance of the tear film. This often results in a small swelling, referred to as a chalazion which can appear on the upper or lower eyelid. A chalazion is essentially a harmless cyst, but it can cause significant discomfort.

A chalazion is normally painless and varies in size, sometimes fluctuating in size over several weeks. A small number of people will go on to form hard eyelid lumps which may need to be removed under local anaesthetic, particularly if they do not go away by themselves after several weeks have passed or if they are particularly unsightly or symptomatic. In rare cases, the chalazion can become infected and this can spread to the rest of the eyelid causing a preseptal cellulitis, which the patient will need antibiotics to treat.

Chalazions are also quite common in children. If a child develops recurrent problems, this could be an indication that they have blepharitis, which is a long-term condition where the edges of the lids are irritated.

A variety of chalazions
"A variety of chalazions demonstrating the varability in presentation. All of these lesions were treated and completely resolved with curettage"

Treatment options

In most cases, a chalazion will disappear on its own over time, which can take several weeks or even months. They do not normally cause a threat to a patient’s health, but can look rather unsightly. In few cases, the lump can blur or block a person’s vision.

Patients can attempt to speed up the resolution and reduce the swelling of the lump by placing a clean, warm compress over it several times per day. Do not try to squeeze the cyst – in fact, it’s better to refrain from touching it as much as possible.

For people with eyelid problems such as blepharitis, a doctor might prescribe an antibiotic ointment for the patient to rub into the bases of the eyelashes before going to sleep and after the lids have been cleaned. This helps to settle irritation. Moreover, if an infection has occurred because of the eyelid cyst, oral antibiotics may be prescribed, but this does not make the cyst go away.

In some cases, surgical treatment might be necessary, particularly if the cyst is large or has been present for a significant amount of time. This is relatively straightforward and is performed under local anaesthesia. The patient is sent home with an eye patch that needs to be removed the next day.

Another option for treatment is the use of steroid injections which can be very effective where there is diffuse inflammation and no discrete lump.

How to prevent chalazion from forming

It is recommended that people clean their eyelids on a daily basis in order to prevent a chalazion from forming. This can be done as part of a daily washing routine, using a warm, soft, wet flannel and a couple of drops of baby shampoo to clean the eyelids before you settle down for the night.

Xanthelasma

This is another eyelid condition which is caused by cholesterol deposition on the inner parts of the upper and lower eyelids and causes a yellowish discolouring and fatty lumps to develop. In many cases, this is caused by having high cholesterol levels in the blood, but some people may still develop it even where their cholesterol levels are normal. The majority of people who develop xanthelasma are middle-aged or older and it is more frequent in women.

Xanthelasma lumps are harmless, but a patient might want to get them removed where their appearance is bothering them. However, it is important to note that even with medical removal, they may reoccur at a later date.

Removal of Xanthelasma

This surgery is carried out under local anaesthetic, which is injected into the eyelid area in order to numb them. Drops are also placed into the eyes to numb them. Once numb, the xanthelasma are cut out of the eyelids, and then the incisions are closed up with small sutures, which are dissolvable and will normally disappear over the following weeks.

After the surgical removal, an antibiotic ointment is applied to the eye area, as well as an eye pad. This ointment will be given to you to take home, and you should continue to use it as instructed.

The eye patch can be taken off after a few hours and you might notice some blood or discharge around the affected area. This is normal and you should wash the area with cool, sterile water. There may be some discomfort for the first couple of days and you can take normal painkillers to help with this. Likewise, bruising and swelling is common for a several weeks after the surgery.

Basal Cell Carcinoma

Basal cell carcinomas (BCC) is the most common type of eyelid cancer and must be removed immediately. If they are left untreated, these tumours can grow in the area surrounding the eye and spread into the orbit, the sinuses and the brain.

People with BCC normally begin to notice a painless lump which has begun to slowly form on the eyelid, most commonly in the lower part of eyelid. A loss of eyelashes are an indication that the tumour is malignant.

 

Treatment for Basal Cell Carcinoma

The first step in treatment is establishing the diagnosis with a bioipsy. Once this has been confirmed, surgery to remove the tumour must be carried out. The tumour excision can be achieved either by an oculoplastic surgeon, or by a dermatologist, using Moh's technique if the tumour is in a sensitive or critical area.

The Moh’s procedure is carried out in stages, whereby layers of tissue are removed and the surgeon examines it under a microscope in a lab. If cancerous cells are detected, the surgeon is able to go back and find the exact location and remove more layers of tissue from that area, whilst keeping as much of the healthy tissue as possible. After confirmation that the tumour has been removed, the eyelid tissues are then reformed.

Eyelid reconstruction is a highly specialised form of surgery which should only be performed by a specialist oculoplastic surgeon.