BENIGN EYELID LESIONS

1. Nodules
Chalazion
Acute hordeola
Molluscum contagiosum
Xanthelasma

2. Cysts
Cyst of Moll
Cyst of Zeiss
Sebaceous cyst
Hidrocystoma
3. Tumours
Viral wart
Keratoacanthoma
Naevi
Capillary haemangioma
Port-wine stain
Pyogenic granuloma
Cutaneous horn
Signs of chalazion (meibomian cyst)

Painless, roundish, firm lesion May rupture through conjunctiva

within tarsal plate and cause granuloma
 Histology of chalazion

Multiple, round spaces previously Epithelioid Multinucleated

containing fat with surrounding cells giant cells
granulomatous inflammation
 Treatment of chalazion

Injection of local anaesthetic Insertion of clamp Incision and curettage

 Acute hordeola
Internal hordeolum External hordeolum (stye)
( acute chalazion )

Staph. abscess of meibomian Staph. abscess of lash follicle and

glands associated gland of Zeis or Moll
Tender swelling within tarsal plate Tender swelling at lid margin
May discharge through skin May discharge through skin
or conjunctiva
 Molluscum contagiosum
Signs Complications

Painless, waxy, umbilicated nodule Chronic follicular conjunctivitis

May be multiple in AIDS patients Occasionally superficial keratitis
Histology of molluscum contagiosum

Lobules of hyperplastic epithelium

Circumscribed lesion
Surface covered by normal
epithelium except in centre
Intracytoplasmic (Henderson-Patterson)
inclusion bodies
Deep within lesion bodies are small and
eosinophilic
Near surface bodies are larger and
basophilic
 Xanthelasma

Common in elderly or those with

hypercholesterolaemia
Yellowish, subcutaneous plaques
containing cholesterol and lipid
Usually bilateral and located medially
 Eyelid cysts
Eccrine sweat gland
Cyst of Moll hidrocystoma

Translucent Similar to cyst of Moll

On anterior lid Not confined to lid
margin margin
Cyst of Zeis Sebaceous cyst

Opaque Cheesy contents

On anterior lid Frequently at
margin inner canthus
Viral wart (squamous cell papilloma)
Most common benign lid tumour
Raspberry-like surface

Pedunculated Sessile
 Histology of viral wart

Finger-like projections of Epidermis shows acanthosis (increased

fibrovascular connective tissue thickness) and hyperkeratosis
Rete ridges are elongated and bent inwards
 Keratoses
Seborrhoeic Actinic

Common in elderly Affects elderly, fair-skinned individuals

Discrete, greasy, brown lesion Most common pre-malignant skin lesion
Friable verrucous surface Rare on eyelids
Flat stuck-on appearance Flat, scaly, hyperkeratotic lesion
 Keratoacanthoma

Uncommon, fast growing nodule Lesion above surface epithelium

Acquires rolled edges and keratin-filled
crater Central keratin-filled crater
Involutes spontaneously within 1 year Chronic inflammatory cellular infiltration
of dermis
 Naevi
Appearance and classification determined by location within skin
Tend to become more pigmented at puberty

Intradermal Junctional Compound

Elevated Flat, well-circumscribed Has both intradermal

and junctional
May be non-pigmented Pigmented components
No malignant potential Low malignant potential
 Capillary haemangioma

Rare tumour which presents soon after birth May be associated with intraorbital
extension
Starts as small, red lesion, most frequently
on upper lid Grows quickly during first year

Blanches with pressure and swells on crying Begins to involute spontaneously

during second year
Periocular haemangioma
Treatment options
Steroid injection in
most cases
Surgical resection in
selected cases
Occasional systemic
associations
High-out heart failure
Kasabach-Merritt syndrome -
thrombocytopenia, anaemia
and reduced coagulant factors
Maffuci syndrome - skin
haemangiomas,
endrochondromas and
bowing of long bones
 Histology of capillary haemangioma

Lobules of capillaries Fine fibrous septae Lobules under high magnification

Port-wine stain (naevus flammeus)

Rare, congenital subcutaneous lesion

Segmental and usually unilateral

Does not blanch with pressure

Associations
Ipsilateral glaucoma in 30%

Sturge-Weber or
Klippel-Trenaunay-Weber
syndrome in 5%
 Progression of port-wine stain

Initially red and flat Subsequent darkening Skin becomes coarse,

and hypertrophy of skin nodular and friable
 Pyogenic granuloma Cutaneous horn

Usually antedated by surgery or trauma Uncommon, horn-like lesion protruding

Fast-growing pinkish, pedunculated or through skin
sessile mass May be associated with underlying actinic
Bleeds easily keratosis or squamous cell carcinoma