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 .
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.