There are many different minor lesions that may affect the eyelid. Most are a cyst or papilloma.
A cyst is caused by a gland, which has become blocked but continues to produce fluid or oil. This collects under the skin as a spherical lump. A papilloma is a warty fleshy growth of skin, also known as a skin tag. They are benign and not a form of skin cancer. Cysts and papillomas may cause irritation, watering of the eye and some people do not like the appearance. Many people ask for them to be removed surgically. Some people are worried that the lump may be cancerous and removing it enables a pathologist to examine it microscopically and exclude skin cancer. It is important not to ignore lesions if they are changing as this may be a sign that the are cancerous.
Chalazion
A chalazion is a small pea sized lump in the eyelid. It is due to blockage and infection in a meibomian gland in the eyelid. The meibomian glands sit within the cartilage of the eyelid and open up in a row behind the eyelashes. They produce oil for the tear film. At first the margin of the eyelid may become red. This progresses to form a lump with redness and swelling of the eyelid skin. This acute phase usually passes within a couple of weeks and may leave a small, non-reddened lump called a chalazion as seen above. Many meibomian gland infections do not develop into a chalazion and will simply settle spontaneously. As soon a red mark on the eyelid is seen intensive hot compresses should be carried out to try to prevent the formation of a chalazion. 6 times a day for 5 minutes at a time. Even once a chalazion has formed most will settle within 3 months without treatment. If it does not settle or if it is particularly large an incision and curettage may be carried out. This is a minor surgical procedure carried out in theatre or treatment room. Local anaesthetic is injected into the eyelid. An incision is made on the inside of the eyelid allowing the contents of the cyst to be drained. No sutures are required. An eye pad may be placed for a few hours after the procedure.
Cyst of Moll
This is a benign cyst of a gland of Moll. This is a small sweat gland that sits at the base of an eyelash. It is a clear fluid filled cyst. It can be treated with surgical excision. Mr McCormick will remove the cyst in its entirety to reduce the risk of recurrence. After surgery ointment will be applied 3 times a day for two weeks.
Cyst of Zeiss
A cyst of zeiss is a benign cyst arising from a gland of Zeiss. Glands of Zeiss are oil glands found at the base of eyelashes along side glands of Moll. Instead of clear fluid they are filled with yellow oily secretions. They may be excised surgically if desired. Afterwards you will need to apply antibiotic ointment 3 times a day for two weeks.
Sebaceous cyst
This is a benign skin cyst. A sebaceous cyst occurs in sebaceous glands in the skin. They can occur anywhere on the body. Sebaceous glands produce oil for the skin hence the yellow colour. They can be excised under local anaesthetic. After surgery small dissolvable sutures may be used. Antibiotic ointment should be applied 3 times a day for 2 weeks.
Papilloma
Papillomas are benign overgrowths of skin. They are also known as skin tags. They may be pink or pigmented as above. They are caused by viral infection with human papilloma virus. Many people are infected with this virus without knowing it. It causes warty growths on the skin. They may be excised surgically under local anaesthetic in a treatment room. After surgery a small scab may form. Antibiotic ointment should be applied to the area 3 times a day for 2 weeks
When is a lesion benign and when is it malignant?
It is important not to mistake a skin cancer for a benign lesion. If there is any doubt, the lesion should be biopsied and sent to a pathologist to determine the diagnosis. Mr McCormick will ask you how the lesion arose and he will examine you carefully. It is usually possible from this history and examination to determine if the lesion is benign or malignant. A malignant lesion grows more rapidly than a benign one. It may ulcerate or bleed. It may from a crust in the centre. It may be painful. The normal shape of the eyelid may change and eyelashes may be lost.
This is a basal cell carcinoma - a malignant skin cancer. It has shiny rolled edges with a pit or crater in the centre. There are dilated blood vessels at the edges.
This is an upper lid basal cell carcinoma that has spread along the margin of the eyelid. The normal anatomy has been lost: eyelashes have gone and the normal square edge to the lid is replaced with a rounded and notched one.
This squamous cell carcinoma has a hard crust on the surface. This sometimes comes off revealing an ulcer underneath. The crust reforms and the ulcer grows.
