Epidermal inclusion cysts are filled with keratin (despite being sometimes called sebaceous cysts), and rupture can incite an inflammatory foreign body reaction. These lesions are slow-growing, firm, elevated, round and often have a central pore. Epidermal inclusion cysts arise from the infundibulum of the hair follicle and are primarily due to occlusion.A drop in visual acuity, relative afferent pupillary defect or sluggish pupils, painful and limited eye movements, proptosis and chemosis are suggestive of orbital cellulitis and require prompt referral to a tertiary centre emergency department for imaging and antibiotic treatment.Ĭysts of the epidermis are the second most common type of benign periocular lesion encountered. Differentiating preseptal from orbital cellulitis involves examination of visual acuity, pupils, extraocular movements and the eyelids. Orbital cellulitis is a rare but potentially sight-threatening and even life-threatening complication that occurs when infection breaches the orbital septum. Associated preseptal cellulitis is common and can be treated with a course of oral antibiotics in addition to hot compress and massage. Hordeolums (styes) are acute bacterial infections of any of the above blocked glands and are classified as either internal (Meibomian gland) or external (Zeis or Moll).Conservative treatment is recommended for at least 1–2 months prior to referral for consideration of incision and drainage. Antibiotics are not required unless there is evidence of superimposed bacterial infection. Treatment involves hot compress, massage and eyelid margin hygiene at least twice per day. Symptoms tend to reflect ocular surface discomfort and can include dryness, gritty sensation and/or epiphora (watery eyes). Associated blepharitis is common, and clinical signs include eyelid margin telangiectasia, erythema and lash crusting. Chalazions present as painless nodules within the tarsal plate (posterior aspect of lid) or at the lid margin and can vary in size. Meibomian glands are modified sebaceous glands present throughout the upper and lower eyelid, in and around the tarsal plate. Chalazions represent focal granulomatous inflammation due to retained Meibomian gland secretions from a blocked duct and are the most common lid lesion.These tend to be filled with yellow oily secretions and do not transilluminate. Cysts of Zeis arise from blocked sebaceous glands, also found on the eyelid margin.Apocrine hidrocystomas are common smooth cysts that are considered adenomas of the secretory cells of Moll rather than classic retention cysts but clinically look similar and may have a bluish colour.They are solitary dome-shaped papules or nodules filled with clear fluid, making transillumination a key feature. Cysts of Moll arise from blocked apocrine sweat glands found on the margin of the eyelid.Common benign eyelid lesions: Translucent cyst of Moll (upper left), cyst of Zeis filled with sebaceous material (upper right), epidermal inclusion cyst filled with keratin (lower left) and molluscum contagiosum (lower right) Figure 1 shows some common benign lesions that occur around the eyelid.įigure 1. Blockage of any of these glands results in corresponding focal collections/cysts, and these are commonly encountered in general practice. There are three types of glands located in the eyelids: Meibomian, Zeis and Moll. Types of benign lesions Lesions arising from glands This article will cover common eyelid lesions and the approach to investigation and management, as well as key red flag signs and rare conditions not to miss. Pattern recognition plays a key part in accurate diagnosis and, combined with careful history-taking and clinical examination, allows for prompt management or further investigation as required. Rarely, eyelid lesions can indicate malignant disease, which has the potential for metastatic spread and associated mortality. Patients with eyelid lesions often present in the primary care setting, with the majority of eyelid lesions indicating benign pathology.
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