Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Eyelid lesions

INTRODUCTION

Conditions that cause lesions of the eyelid include benign and malignant diagnoses. Patients with eyelid abnormalities commonly present to their primary care physician. Primary care clinicians, therefore, must be able to identify serious conditions that require urgent referral and to provide appropriate therapy for treatable benign conditions.

This topic will discuss the differential diagnosis of non-acute lesions that affect the eyelid. Eyelid lacerations, blepharitis, and the differential diagnosis of the red eye are discussed separately. (See "Eyelid lacerations" and "Blepharitis" and "Evaluation of the red eye".)

BENIGN NODULAR LESIONS

Xanthelasma — Xanthelasma are cholesterol-filled, soft, yellow plaques that usually appear on the medial aspects of the eyelids bilaterally (picture 1). They most often occur in middle-aged and older adults.

Hyperlipidemia is present in approximately 50 percent of patients with xanthelasma [1,2]. These lesions are a classic feature of primary biliary cirrhosis, a condition often associated with marked hypercholesterolemia (see "Hypercholesterolemia and atherosclerosis in primary biliary cirrhosis"). They are also common in patients with primary disorders of low-density-lipoprotein (LDL)-cholesterol metabolism; they occur in 75 percent of older patients with familial hypercholesterolemia, and 10 percent of patients with hyperapobetalipoproteinemia (see "Inherited disorders of LDL-cholesterol metabolism"). Young individuals, in particular, with xanthelasma, appear to have a relatively high prevalence of lipoprotein abnormalities [3].

In normolipidemic individuals, the possible association between xanthelasma and atherosclerosis is not clear. Some studies have noted other lipoprotein abnormalities in normocholesterolemic patients with xanthelasma that may increase the risk of coronary heart disease, including low levels of high-density-lipoprotein (HDL)-cholesterol [2,4]. Thus, it is reasonable to obtain a lipid profile in patients with xanthelasma.

                                  

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jun 2014. | This topic last updated: Sep 27, 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Vinger PF, Sachs BA. Ocular manifestations of hyperlipoproteinemia. Am J Ophthalmol 1970; 70:563.
  2. Bergman R. The pathogenesis and clinical significance of xanthelasma palpebrarum. J Am Acad Dermatol 1994; 30:236.
  3. Segal P, Insull W Jr, Chambless LE, et al. The association of dyslipoproteinemia with corneal arcus and xanthelasma. The Lipid Research Clinics Program Prevalence Study. Circulation 1986; 73:I108.
  4. Watanabe A, Yoshimura A, Wakasugi T, et al. Serum lipids, lipoprotein lipids and coronary heart disease in patients with xanthelasma palpebrarum. Atherosclerosis 1981; 38:283.
  5. Fujita M, Shirai K. A comparative study of the therapeutic effect of probucol and pravastatin on xanthelasma. J Dermatol 1996; 23:598.
  6. Haygood LJ, Bennett JD, Brodell RT. Treatment of xanthelasma palpebrarum with bichloracetic acid. Dermatol Surg 1998; 24:1027.
  7. Doi H, Ogawa Y. A new operative method for treatment of xanthelasma or xanthoma palpebrarum: microsurgical inverted peeling. Plast Reconstr Surg 1998; 102:1171.
  8. Raulin C, Schoenermark MP, Werner S, Greve B. Xanthelasma palpebrarum: treatment with the ultrapulsed CO2 laser. Lasers Surg Med 1999; 24:122.
  9. Ben Simon GJ, Huang L, Nakra T, et al. Intralesional triamcinolone acetonide injection for primary and recurrent chalazia: is it really effective? Ophthalmology 2005; 112:913.
  10. Lindsley K, Nichols JJ, Dickersin K. Interventions for acute internal hordeolum. Cochrane Database Syst Rev 2010; :CD007742.
  11. Waugh MA. Molluscum contagiosum. Dermatol Clin 1998; 16:839.
  12. Bardenstein DS, Elmets C. Hyperfocal cryotherapy of multiple Molluscum contagiosum lesions in patients with the acquired immune deficiency syndrome. Ophthalmology 1995; 102:1031.
  13. Margo CE, Waltz K. Basal cell carcinoma of the eyelid and periocular skin. Surv Ophthalmol 1993; 38:169.
  14. Cook BE Jr, Bartley GB. Epidemiologic characteristics and clinical course of patients with malignant eyelid tumors in an incidence cohort in Olmsted County, Minnesota. Ophthalmology 1999; 106:746.
  15. Doxanas MT, Green WR, Iliff CE. Factors in the successful surgical management of basal cell carcinoma of the eyelids. Am J Ophthalmol 1981; 91:726.
  16. Cook BE Jr, Bartley GB. Treatment options and future prospects for the management of eyelid malignancies: an evidence-based update. Ophthalmology 2001; 108:2088.
  17. Mohs FE. Micrographic surgery for the microscopically controlled excision of eyelid cancers. Arch Ophthalmol 1986; 104:901.
  18. Frank HJ. Frozen section control of excision of eyelid basal cell carcinomas: 8 1/2 years' experience. Br J Ophthalmol 1989; 73:328.
  19. Buschmann W. A reappraisal of cryosurgery for eyelid basal cell carcinomas. Br J Ophthalmol 2002; 86:453.
  20. Reifler DM, Hornblass A. Squamous cell carcinoma of the eyelid. Surv Ophthalmol 1986; 30:349.
  21. Shields JA, Demirci H, Marr BP, et al. Sebaceous carcinoma of the eyelids: personal experience with 60 cases. Ophthalmology 2004; 111:2151.
  22. Kass LG, Hornblass A. Sebaceous carcinoma of the ocular adnexa. Surv Ophthalmol 1989; 33:477.
  23. Doxanas MT, Green WR. Sebaceous gland carcinoma. Review of 40 cases. Arch Ophthalmol 1984; 102:245.
  24. Zürcher M, Hintschich CR, Garner A, et al. Sebaceous carcinoma of the eyelid: a clinicopathological study. Br J Ophthalmol 1998; 82:1049.
  25. Muqit MM, Roberts F, Lee WR, Kemp E. Improved survival rates in sebaceous carcinoma of the eyelid. Eye (Lond) 2004; 18:49.
  26. Hornblass A, Lauer SA. Sebaceous carcinoma of the eyelids. Ophthalmology 2004; 111:2149.
  27. Scully JP. Treatment of seborrheic keratosis. JAMA 1970; 213:1498.
  28. Scott KR, Kronish JW. Premalignant lesions and squamous cell carcinoma. In: Principles and practice of ophthalmology: clinical practice, Albert DM, Jakobiec FA (Eds), WB Saunders, Philadelphia 1994. Vol 3, p.1733.
  29. Folberg R. Eyelids: Terminology of eyelid pathology. In: Pathology of the eye (CDROM), Folberg R (Ed), Mosby-Year Book, St. Louis 1996.
  30. Weiss RD. Orbital disease. In: Oculoplastic Surgery, 3rd ed, McCord CD, Tanenbaum M, Nunery WR (Eds), Raven Press, New York 1995. p.417.
  31. Margo CE, Habal MB. Large congenital melanocytic nevus. Light and electron microscopic findings. Ophthalmology 1987; 94:960.
  32. McCormick SA, DeLuca RL. Tumors of melanocytic origin. In: Eye and skin disease, Mannis MJ, Macsai MS, Huntley AC (Eds), Lippincott-Raven, Philadelphia 1996. p.381.
  33. Garner A, Koornneef L, Levene A, Collin JR. Malignant melanoma of the eyelid skin: histopathology and behaviour. Br J Ophthalmol 1985; 69:180.
  34. Dummer R, Graf P, Greif C, Burg G. Treatment of vascular lesions using the VersaPulse variable pulse width frequency doubled neodymium:YAG laser. Dermatology 1998; 197:158.
  35. Kushner BJ. Intralesional corticosteroid injection for infantile adnexal hemangioma. Am J Ophthalmol 1982; 93:496.
  36. Friedman-Kien AE, Saltzman BR. Clinical manifestations of classical, endemic African, and epidemic AIDS-associated Kaposi's sarcoma. J Am Acad Dermatol 1990; 22:1237.