All about eyelid lumps

Eyelid lumps can appear in many forms and have a range of different causes. While eyelid lumps are generally benign, some may cause symptoms or be bothersome in appearance.

Here to provide an expert insight into eyelid lumps is Mr Robert Peden, renowned consultant ophthalmic and oculoplastic surgeon based in Edinburgh.

Can you explain the different types of eyelid lumps, and how do they typically present?

There are various types of eyelid lumps that can occur, both benign and malignant, and each type may present differently.

Common types of eyelid lumps include:

• Stye: A stye is a small, typically painful abscess (a collection of pus) on the eyelid that can be quite tender to the touch. It often appears as a red or pink lump with a yellow spot in the middle. The area around the stye may also be swollen or red, and there may be an excessive tearing in the affected eye.
• Chalazion (plural: chalazia): A chalazion originates on the inside of the eyelid, and appears as a firm lump on the eyelid that may be red or skin-coloured. If a chalazion presses against the eye, it may cause mild discomfort, light sensitivity, and blurred vision.
• Xanthelasma: Xanthelasma are small, yellow areas of fatty cholesterol deposits that typically develop underneath the skin around the eyelids. They can appear as flat strips or as raised bumps. Although generally painless, xanthelasma are unlikely to resolve without treatment and may be cosmetically bothersome.
• Papilloma: Papillomas are benign overgrowths of skin, and often have a warty appearance. They are typically skin-coloured, and sometimes have a small stalk (pedunculated). They are generally painless, but can cause irritation, and can also be removed for cosmetic reasons.
• Cysts of Moll/Cysts of Zeis: These are cysts that can appear on the eyelids, filled with either fluid (cysts of Moll) or thicker, pale material (cysts of Zeis). 
• Seborrheic keratosis: Seborrheic keratosis tends to appear more commonly with increasing age. They are usually raised, brownish lesions with a rough, oily surface.
• Naevus: These are usually round or oval, and may be pigmented with a consistent colour. They commonly appear on the edge of the eyelids.
• Basal cell carcinoma (BCC): BCCs are a form of localised skin cancer, sometimes called a rodent ulcer. They don’t spread elsewhere in the body, but can destroy the tissues where they are growing. They often have pearly edges, sometimes with a central crater or ulcer, and sometimes bleed.
• Squamous cell carcinoma (SCC): SCCs can have quite varied appearances, sometimes mimicking other lesions. They are much less common than BCCs, but can spread widely, including along nerves, and can metastasise elsewhere in the body.

The appearance and symptoms of eyelid lumps can vary, and a correct diagnosis is crucial to determine the most appropriate course of action.

What can cause eyelid lumps, and what are the underlying medical conditions associated with their development?

Eyelid lumps can have various causes, and some may be associated with underlying medical conditions.

Styes form when an oil-producing gland or an eyelash follicle becomes infected by bacteria - usually the Staphylococcus aureus bacteria. This bacteria causes inflammation within the eyelid.

Chalazia are caused by a blockage of one of the meibomian glands. When a meibomian gland becomes blocked, this can lead to inflammation and the accumulation of oil in the eyelid, resulting in the formation of a chalazion.

Xanthelasma are caused by high levels of cholesterol in the blood, which lead to the accumulation of cholesterol deposits within the skin of the eyelids.

Papillomas are sometimes associated with certain viruses which can infect the cells of the skin.

Seborrheic keratoses are more common when there is a history of significant sun exposure over time.

BCCs and SCCs are also associated with sun exposure, as well as age, long-term dampening of the immune system (such as with certain medications), radiation exposure (e.g. previous radiotherapy), fair skin, as well as certain genetic conditions.

What is the non-surgical treatment for an eyelid lump? When is surgery required for its removal?

The choice of treatment for an eyelid lump depends on the specific type of lump and its underlying cause.

Conservative treatment for eyelid lumps involves:

• Warm compresses: For early-stage styes or chalazia, warm compresses can often help. Applying a clean, warm, damp cloth or a heat pad to the affected area for about 10-15 minutes several times a day followed by massage in the direction of the eyelashes can help to encourage drainage.
• Antibiotics: In some cases of eyelid infections, topical antibiotics or eye drops may be prescribed. For more severe infections, oral antibiotics may be prescribed to clear the infection.
• Medications: In some instances, medications may be prescribed to manage underlying medical conditions associated with eyelid lumps, such as medication to lower the level of cholesterol in the blood for xanthelasma cases.

Surgery may be required if conservative treatments are ineffective. There are two main procedures:

• Incision and drainage: Incision and drainage is a minor surgical procedure often used for styes or chalazia that don’t respond to warm compresses or medication. During the procedure, your surgeon will make a small incision on the eyelid to drain the pus.
• Excision: Excision may be recommended for a number of eyelid lesions if they interfere with vision or for cosmetic reasons. During the procedure, your surgeon will surgically remove the lesions under local anaesthetic and then close the incisions if needed using dissolving sutures. If there is a significant suspicion that the lesion is malignant, then typically it should be excised with a surrounding area of normal-looking tissue to ensure any remaining tumour cells are removed (sometimes a biopsy is done prior to excision to confirm the diagnosis before removal).

Occasionally other treatments are indicated, such as steroid injection or electrodessication, and these will be discussed with you by your surgeon if appropriate.  

What are the potential risks and complications associated with the surgical removal of an eyelid lump?

Eyelid lump removal, like any surgical procedure, carries certain potential complications.

Bruising and swelling will generally occur to a greater or lesser degree with any surgery, including eyelid surgery.

There is a risk of infection following eyelid surgery, which is usually indicated by redness, swelling, pain and discharge from the surgical site. Infections, however, are very uncommon, and can be treated with antibiotics.

In addition, and depending on the surgical technique, there may also be a bit of visible scarring. Your surgeon, however, can work to minimise the scarring, for example by placing incisions within natural eyelid creases.

Some lesions can recur, and complete excision with cautery of the base of the lesion can help to reduce the chance of this.

Although rare, allergic reactions to the anaesthesia are also possible.

It’s important to discuss any potential complications with your surgeon before having eyelid lump removal. Your surgeon will assess your specific situation, explain the risks and benefits, and provide post-operative instructions for your care and recovery.

It is generally a good idea to consult with an eyelid specialist (oculoplastic surgeon) for removal of eyelid lesions to ensure accurate diagnosis and to minimise the risk of complications.

What can I do to prevent future eyelid lumps?

Preventing future eyelid lumps involves maintaining good eyelid hygiene, particularly if there is blepharitis present, as well as addressing any underlying medical conditions that may contribute to their development (such as high cholesterol).

Here are some steps you can take to reduce the risk of future eyelid lumps:

1. Maintain hygiene: Clean your eyes regularly, especially if you are prone to styes or chalazia, using a mild eyelid cleanser or baby shampoo diluted with warm water. Gently scrub the base of your eyelashes to remove debris and bacteria. If you wear eye makeup, remember to remove your makeup before bedtime using a gentle cleanser to prevent clogged oil glands and reduce the risk of infection. Wash your hands frequently, and avoid touching your eyes with dirty hands. If you have posterior blepharitis (Meibomian gland dysfunction) then long-term treatment with heat followed by massage of the eyelids can help to reduce the chance of oil gland blockage.
2. Protect your eyes: Use appropriate eye protection when necessary, such as safety glasses or goggles, to prevent foreign bodies from entering your eyes. Wear sunglasses with UV protection to shield your eyes and eyelids from the sun's harmful rays, which can help reduce the risk of skin lesions and skin cancer.
3. Manage underlying medical conditions: If you have underlying medical conditions like blepharitis (eyelid inflammation), seborrhoeic dermatitis, or high cholesterol, consult a healthcare professional on how to manage and treat these conditions.
4. Eye exams: Schedule regular eye examinations with a healthcare professional to detect and address any eye-related issues early.

If you notice a new eyelid lump or a change in your eyelid, seek medical attention promptly for an accurate diagnosis and appropriate treatment. Early intervention can improve outcomes.

If you’re worried about a new eyelid lump, don’t hesitate to book an appointment with Mr Robert Peden via his Top Doctors profile today to receive expert diagnosis and treatment.