Eyelid Lesions.
The eyelid can develop many different types of benign lesions.
These are usually easy to diagnose and treat within the clinic without any need for a hospital procedure.
Eyelid lesions
There are many different types of lumps and bumps that can form within our eyelids. These can be described as eyelid “lesions”. Generally speaking, an eyelid lesion can be classified as non-cancerous (benign) or cancerous (malignant). In this section, we will be discussing benign eyelid lesions.
Eyelid lesions are usually classified according to which part of the eyelid structure they originate from, whether it be the skin, sweat or oily glands, or eyelash follicles.
Some common eyelid lesions are: (with pictures)
1. From the skin:
Papilloma (squamous cell papilloma)
Cyst (epidermoid or epidermal inclusion cyst)
Seborrheic keratosis (“age wart”)
2. From the glands:
Meibomian cyst (chalazion)
Sebaceous cyst (from the oily glands)
Cyst of Moll (from the sweat glands)
3. From the pigment cells in skin (nevus cells/melanocytes)
Freckle
Mole (intradermal nevus, compound nevus)
4. Xanthelasma (“cholesterol deposits”)
Most benign eyelid lesions can be diagnosed by naked-eye (clinical) examination by Dr Then.
However, in order to make a 100% certain diagnosis, Dr Then may recommend a biopsy procedure, whereby a sample of the lesion is taken and sent to the pathology laboratory for analysis.
At Peel Vision, we have a dedicated procedure room for the biopsy and removal of eyelid lesions.
On the day of the biopsy, you will be taken into the procedure room and placed comfortably in a semi-reclined chair. Your eyelid will be washed with an antiseptic solution and a local anaesthetic injection placed in the skin around the eyelid lesion. This will completely numb the area so that you do not feel the biopsy.
Dr Then will then take a sample of tissue from the eyelid lesion. If the lesion is small and well-defined, the biopsy will remove the entire lesion. The sample is then placed in a formalin solution, labelled and sent to our local Pathology laboratory for analysis.
After the biopsy, a heat cautery device is used to dry up any bleeding from the biopsy site, and an eye patch may be placed over the area. If there is not much bleeding, then an eye patch may not be required. Any eye patch can generally be removed after 4 hours.
Dr Then will prescribe an antibiotic cream (Chlorsig) to be placed 4 times per day for up to 1 week on the biopsy site, to reduce the risk of infection.
We will normally receive results from the Pathology laboratory within 10 days. There is generally no need to return for an appointment for this result, as Dr Then will send the report directly to your referring doctor or GP. If the biopsy does return an unexpected result (eg. a skin cancer), then you will be contacted to make an appointment to discuss this with Dr Then.
The biopsied area will usually heal very well within 2 weeks, with normal skin growing back at the site and minimal scarring. There is no need to see us for a follow-up visit unless you develop a problem with the biopsy area.
If the eyelid lesion is small and well-defined, the biopsy will remove the entire lesion and no further surgery is required.
If the eyelid lesion is large or multiple, then Dr Then may recommend further surgery (after the biopsy) to remove the remaining lesion(s). This may be performed in our procedure room in the clinic, or in the hospital, depending on the extent and complexity of surgery required.
Chalazion (meibomian cyst)
A chalazion (otherwise known as a Meibomian cyst) is a firm swelling in the eyelid due to chronic inflammation of the oil-producing glands (Meibomion glands) located in the upper and lower eyelids. These glands normally secrete the oily (sebaceous secretions) layer of the tear film.
Chalazia are a common problem and can occur in any age group. They are more common in adults than children. Hormonal influences on sebaceous secretions may explain a slight increased incidence during puberty and during pregnancy.
Chalazia occur when the openings of the Meibomian glands onto the eyelid margin become blocked. This leads to trapping of the sebaceous secretions of the glands within the eyelid, which then becomes chronically inflamed. This results in a firm and usually painless inflammatory lump within the eyelid itself.
Patients prone to developing chalazia often have chronic dysfunction of their Meibomian glands. This leads to abnormal thickening of the sebaceous secretions, and when the eyelid is squeezed, toothpaste-like matter is seen rather than healthy clear oily secretions. Patients often have blepharitis (see Information sheet on Blepharitis) or inflammation of the eyelid margin.
Chalazia are not usually due to poor eyelid hygiene or the application of eye make-up.
Chalazia are occasionally confused with Styes, which can also appear as a lump on the eyelid. However, Styes are due to acute bacterial infection at the base of an eyelash follicle and present as more painful lumps closer to the edge of the eyelid.
Chalazia most often present as painless firm lumps within the upper or lower eyelid. They are often easier to feel than see. Sometimes they present as areas of redness close to the eyelid margin (marginal chalazion). Occasionally, if the trapped sebaceous secretions within the eyelid become infected, a chalazion can present as a tender red swelling of the whole eyelid. Patients may develop several chalazia at the same time in different eyelids.
Chalazia may spontaneously “burst” and release a thick mucoid discharge into the eye. They often “point and release” this discharge toward the back of the eyelid, rather than through the skin, and often reform again. They can persist for weeks to months in some patients.
Chalazia rarely cause visual problems and are not a threat to the eye itself. However, if very large, they can cause visual disturbance.
Your ophthalmologist will diagnose a chalazion by examination of your eyelids in fine detail under the slit lamp microscope.
Small chalazia may disappear on their own or respond to simple treatment with warm compresses and eyelid massage.
The warmth of the compresses will melt any trapped oily secretions, and the mechanical action of the eyelid massage will help dislodge any thickened secretions from gland openings, as well as encourage movement of trapped secretions out of the eyelid.
Technique of warm compresses and eyelid massage:
- First, apply a warm moist towel onto the eyelids for 2-5 mins.
- Whilst the eyelids are still warm, use your index finger to firmly massage over any eyelid lump in a direction TOWARD the eyelid margin (where the eyelashes are). That is, for upper eyelid lumps, massage DOWN toward the eyelid margin, and for lower eyelid lumps, massage UP toward the eyelid. Apply 10 strokes in each massage and repeat 4 times per day.
In some cases, chalazia will persist despite warm compresses and massage.
If they are large and symptomatic, then your ophthalmologist will perform a simple procedure to drain the chalazia. This can often be done in the office under local anaesthetic.
Technique of surgery:
A small amount of anaesthetic will be injected into the skin of the eyelid over the lump.
A small eyelid clamp will be used to allow access to the undersurface (back surface) of the eyelid, and an incision made through the undersurface of the lump. A fine curette is then used to gently clean and remove the inflamed secretions. No sutures are required. Antibiotic ointment is placed in the eye and an eye pad is worn for a few hours after.
As no cuts are made into the skin of the eyelid, there is no visible scarring from this procedure. After the procedure, the eye may feel gritty or have a mild foreign-body sensation in it for a few days. You are given an antibiotic ointment to put in the eye for 1 week, and continue to apply warm compresses and massage. You are generally reviewed 2-3 weeks after the procedure.
Occasionally, chalazia may still recur after this procedure. But with long-term application of warm compresses and eyelid hygiene, this risk is greatly reduced.
Steroid injections or ointments:
If chalazia are very inflamed (red and swollen), then the injection of steroid (anti-inflammatory) medication into the chalazia can greatly hasten resolution, and sometimes allow surgery to be avoided. This procedure is done in the office. The steroid is injected with a fine needle (after the application of a local anaesthetic injection), and lasts about 1 month. There is very little risk with this procedure. Rarely, it may cause depigmentation of the skin of the eyelid, in darker-skinned patients. Very rarely, it can lead to raised eye pressures.
Steroid eye ointments are occasionally useful to help reduce severe eyelid inflammation, which will encourage drainage of trapped secretions and provide symptomatic relief. However, they should only be applied for a short course and under supervision. Long-term unsupervised use can lead to eye complications, particularly raised eye pressure.
Antibiotics:
As this is not an infection, antibiotics do not play a large role in the treatment of chalazia. Antibiotic eye drops are not useful, and may actually cause unnecessary side effects.
Some patients with significant Meibomian gland dysfunction or posterior blepharitis may benefit from a 6-12 week course of low-dose doxycycline tablets, to help reduce inflammation and recurrence.
Any eyelid lump which persists or keeps coming back, despite proper treatment, must be treated with suspicion. In rare cases, certain eyelid tumours, particularly sebaceous carcinoma (tumour of the Meibomian glands) can mimic a chalazion. If your ophthalmologist suspects this, then a biopsy of the eyelid will be performed to investigate for this.
Always consult your ophthalmologist if your “chalazia” does not go away.
