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Eyelid Lesions and Cancers

Eyelid Lesions

Blepharitis

One of the most common eyelid problems is blepharitis, or inflammation of the eyelid margin. Typical symptoms are itching, burning, mild foreign-body sensation, tearing and crusting around the eyes on awakening. Blepharitis occurs with chronic bacterial lid infection, oil gland dysfunction, seborrhea and acne rosacea that affects the eye, known as ocular rosacea.

Debris found amid eyelashes

Treatment of blepharitis consists initially of warm compresses, eyelid scrubs and application of antibiotic ointment. Warm compresses should be applied for 15 minutes twice a day. The eyelids should be scrubbed after the warm compress is removed. Baby shampoo mixed with water produces a soapy solution. With the eyelids closed, the eyelid margin region should be gently scrubbed with this solution, using a cotton-tipped applicator, wash cloth or finger. Antibiotic ointment should be applied only at bedtime, because it may temporarily blur vision. If an obvious infection is present, antibiotic eye-drops may also be used.

Blepharitis is a chronic disease and eyelid hygiene may need to be continued indefinitely. When the process is brought under better control, once-daily eyelid scrubs may be sufficient to keep the problem in check.

Eyelid Cysts

These are benign lesions due to blockage of glands in the eyelid skin. They can be excised if they are large or causes irritations.

Papilloma (Skin Tags)

Papillomas are benign lesions; sometimes caused by a virus. They rarely require surgery except when they cause irritation.

Chalazion

Chalazia appear most commonly as chronic subcutaneous nodules within the eyelid. Initially, a chalazion may be tender and erythematous before evolving into a non-tender lump. Blepharitis is frequently associated with chalazia.

Chalazion causes a lump on the outer corner of the upper lid

A chalazion results from the obstruction of the eyelid oil gland. The blockage of the gland's duct at the eyelid margin results in release of the contents of the gland into the surrounding eyelid soft tissue. For the first few days, a chalazion can cause severe discomfort. Occasionally, chalazia become infected.

Management includes warm compresses applied for 15 minutes four times a day. Blepharitis, if present, should be treated. A topical antibiotic may be used if signs of infection are present. If the lesion persists after four weeks of medical therapy, it may be incised and drained. Rarely, the chalazion is injected with steroids; however, this may result in hypopigmentation of the overlying skin.

Hordeolum (Stye)

A hordeolum, also known as a stye, is an acutely presenting, red, painful lump within the eyelid. A stye can result in infection of the oil gland and may evolve into a chalazion. Styes usually drain spontaneously after one week of treatment with warm compresses 3-4 times a day and topical antibiotic ointment nightly. Incision and drainage are required for non-resolving lesions.

Stye with redness and lump present at the lash line

Nevus (Mole or Birthmark)

Nevus is the medical term for mole or birthmark. Moles are well-defined, flat or raised, dark or light lesions from birth. They may become darker, more raised or cystic during adolescence or young adulthood. Darker moles can turn into cancer. Therefore moles that have changed appearance should be removed and examined for cancer.

Lighter mole on the right; darker mole on the left.


Eyelid Cancers

Basal cell carcinoma makes up more than 90% of eyelid cancers. The lower eyelids are involved in more than 70% of cases, followed by the corner of the eye, upper eyelid and the side corner of the eye. This cancer can cause significant damage to the eyelid. It can recur (come back) to the same area or nearby if the entire tumor is not removed. The tumors usually do not spread to lymph nodes or distant organs.

Squamous cell carcinoma occurs less often on the eyelid than basal cell carcinoma, but it is more aggressive. It can spread to nearby lymph nodes and other parts of the body. The main treatment for this type of eye cancer is surgical removal. Radiation therapy or other treatments may be used in addition to surgery if a large area is affected or if the tumor cannot be fully removed.

Melanoma accounts for about 1% of eyelid cancers. It is a potentially life-threatening type of skin cancer that can affect the eyelid skin or the conjunctiva (the soft pink tissue covering the white part of the eye). It is very aggressive and may present with early metastasis in the nearby lymph nodes that drain an eyelid or conjunctival melanoma. Sentinel lymph node biopsy can help stage melanomas of the eyelid and conjunctiva and offer early interventions that increase your chances for successful treatment.

Sebaceous carcinoma (cancer of the oil glands) is a rare type of eye cancer which affects the meibomian glands of the eyelids, conjunctiva or other ocular surface structures. These glands normally produce the oily layer of the tear film, the liquid layer that covers the eye. It can be mistaken for non-cancerous conditions like a chalazion, a small cyst known as a stye. If a stye does not heal with medical treatment or surgical drainage, a biopsy should be done. Treatment requires surgical removal, and the defect in the eyelid is reconstructed with various techniques depending on the size and location of the tumor. Sometimes topical chemotherapy is used after the surgical area has healed.