Author: Dr. Keti Pachkoria
Living in a warm climate like Costa del Sol, Spain, with up to 2,905 sunshine hours a year, places us at a higher risk of sun-related skin damage around the eyes. Both upper and lower eyelids are extremely vulnerable to injury from the sun’s ultraviolet (UV) rays.
Eyelid lesions can be benign, this means they are localised and do not invade the adjacent tissue, or malignant, this means they can invade the surrounding tissue, the eye and other parts of the body, see Figure 1. Unfortunately, cancerous tumours on the eyelids can easily be mistaken for benign lesions. Patients, very often, ignore small, slowly growing and asymptomatic lumps on the eyelids hoping lesions to resolve by itself. Many don´t attend the appointment until noticeable cosmetic issues arise such as change in colour, size, shape and function of the eyelid.
As an eye surgeon, I often treat and manage patients with eyelid lesions. Benign eyelid lesions may have incredible sounding names, unlike the names these are easy to excise. I do eyelid lesion removal procedures under the local anaesthesia and after few days (3-5 days) of downtime, the eyelids settle very well. On some occasion, I may also advise biopsy to rule out cancerous tumours. Malignant lesions may be fully removed by simple excision if diagnosed early, depending on the size and extension of lesion, I may perform eyelid reconstruction or advise more advanced treatment such as radio and/ or chemotherapy.
You should see the ophthalmologist if you have:
- long-standing lesions/lumps/bumps on the eyelid
- long standing thickening of the eyelid
- chronic eyelid infection
- broken skin, bleeding from the eyelid
- growth, change in shape and colour of the lesion
- change in the position or direction of the eyelid
Please feel free to book appointment with us to talk though the changes in your eyelid or periocular skin and take necessary action in good time for early treatment of any precancerous or cancerous eyelid skin lesions.
Figure 1
| Benign eyelid lesions | |
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Chalazion Chalazia may present with acute inflammation but often are non-tender. External hordeola involve lash follicle, while internal forms are often due to bacterial infection of a meibomian gland. |
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Epidermal inclusion cyst These are white or yellow colour, solid, slow growing benign cyst. Treatment is by removal of entire cyst wall to prevent recurrence. |
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Xanthelasma These are benign lesions located in the inner corner of the upper and/or lower eyelid, yellow plaques are filed with lipid-laden macrophages. Depending on the extend of the lesion, these may surgically removed, other non surgical treatment are available with the higher recurrence rate. |
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Seborrheic Keratoses These are elevated, pigmented, greasy, stick-on-plaques benign lesion. Sudden increase in size or number of the lesion may indicate a systemic malignancy. |
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Eecrine cyst Eecrine cysts are translucent nodules, small round/oval shaped benign associated with sweat glands. They often grow and may recure. |
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Verruca Vulgaris These lesions also known as a viral wart, caused by human papilloma virus. Two forms exist: filiform (projecting) and plana (flat) lesions. They may be removed by excision. |
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Ectropion Ectropion is a medical condition that causes the lower eyelid to turn outward causing dry eye, tearing, irritation, pain, visual deterioration,etc. In some cases, ectropion can appear after the lower eyelid blepharoplasty, when too much skin is removed during the surgery, this may result in downward lower lid movement. Eyelids can be surgically repaired and place in it´s natural position to other ocular and cosmetic issues. |
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Entropion Entropion is a medical term for malposition of the eyelid, the lower eyelid turns inward so that the eyelashes rubs against the window of the eye causing irritation, tearing, foreign body sensation, blurry vision, etc. Sometimes eyelid malposition can only be evident after squeezing the eyelids closed. Entropion can be easily managed by surgery. |
| Malignant Eyelid lesions | |
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Basal cell carcinoma (BCC) This is the most common malignant cancer of the eyelid. Fear skin individuals are prone to develop BCC at sites of sun exposure. Diagnosis of BCC is made by slit lamp examination, lesion often has vascular pearly borders and is confirmed histologically following incisional biopsy. Central ulceration can represent the aggressive type of cancer. BCC is associated with low rates of recurrence once fully excised. |
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Squamous cell carcinoma (SCC) SCC are not as common as BCC and when diagnosed it is important to rule out extension of the tumour. SCC may appear in patients with history of longstanding UV light exposure, cigarette smoking, oil derivates and arsenic exposure, having underlying precancerous lesion such as actinic keratosis, it affect older and immunosuppressed individuals. Surgical removal is the treatment of choice for SCC and in some cases may require grafts, flaps, or radical surgery combined with radio or chemotherapy. |
Prevention is better than cure
Minimize sun exposure by use of sunscreen SPF 50 products, you can contact clinic if you wish to purchase SPF 50 cream suitable for the eyelids and face. Also, use hats and sunglasses, broad-brimmed hats are excellent choice, wear appropriate clothing and remember to never look directly at the sun!!
