Eyelid Lesions and Swelling

Eyelid lesions can either be darkly pigmented or skin-colored and occur when there is a pathological change with the tissue of an eyelid. These lesions can be benign, but some can be cancerous. Symptoms and treatments of eyelid lesions are dependent upon the type.

Types of Eyelid Lesions

There are a significant number of different types of eyelid lesions. Some of the more common include:

• Seborrheic Keratoses – This is the most common type of benign tumor, which can occur anywhere on the body — not just the eyelids. These lesions have an uneven stuck on appearance and can sometimes be itchy. Treatment is not always necessary, but they can be removed for cosmetic reasons. In some cases, they may interfere with vision, warranting removal.
• Acrochordon/Papilloma – Originating in the epithelium, or outer layer of skin of the eyelid, these lesions are associated with aging and are often referred to as a “skin tags” when found elsewhere on the body.
• Nevus – More commonly known as a mole, nevi can appear on eyelids, but removal is not necessary unless the nevus becomes painful or begins to change shape.
• Hemangioma – These benign lesions composed of fine blood vessels may appear shortly after birth in the eyelid or eyebrow (capillary hemangioma) and require treatment if impairing the visual axis. In older adults, small “cherry” hemangiomas may require no treatment at all unless cosmetically bothersome.
• Actinic Keratosis – These scaly, white patches are often precancerous lesions and should be evaluated and treated.
• Xanthelasma – These yellowish lesions typically appear on the inner aspect of the upper eyelids and are cholesterol deposits. Surgical removal is the most effective treatment method but lesions may recur after surgery. Systemic cholesterol should be controlled and patients may be referred to their primary care doctor for a cholesterol test.
• Hidrocystomas – Benign cystic lesions composed of sweat gland cells. Most commonly, these occur at the outer or inner corners of the eyelids but can occur anywhere along the lid margin. Excision is relatively simple with the inner corner being more challenging if it grows close to the punctum, the drainage opening of the draining tear duct.
• Chalazion – Benign inflammatory nodules filled with meibum – the oily secretions of the eyelid that help with tear film stability. These are usually non-infected inflammatory nodules that will sometimes resolve with medical therapy. If they do not, in office drainage and curettage are usually curative.

Diagnosis

Eyelid lesions can often be identified via careful direct examination in the office, but confirmation is usually recommended with tissue examination under a microscope in the event that a lesion is excised.