So, you’ve glanced in the mirror and just noticed a little bump on your upper eyelid. Is this something to be worried about? Could it be skin cancer, or is it just a benign lesion? Do you need to see someone about it? There are many types of eyelid bumps and lid lesions; some need urgent attention, while others will resolve with simple warm compresses. This is what you should know about eyelid bumps and lesions.
Styes and Chalazia
Styes and chalazia are often confused – many people will classify a chalazion as a stye. However, they are two separate types of benign eyelid lesions.
A stye, also known as a hordeolum, may be internal or external. They can appear along the eyelid margin or further within the lid. An external stye is a bacterial infection of the sebaceous glands around the eyelashes, known as the glands of Zeis and Moll; it can look like a pimple. Conversely, an internal stye is an infection of the oil glands deeper within the lid, known as the meibomian glands. These look like a red, soft bump on the eyelid. There are numerous oil glands on both the upper and lower eyelid, so you may find you can have more than one eyelid bump at a time. Styes tend to be red and painful to touch and can start as a generalised swelling of the lid tissues.
Chalazia, or singular chalazion, is a blockage of a meibomian gland of the lid. Unlike a stye, it doesn’t involve an active infection. A chalazion may appear as a slightly tender, red, swollen bump on the lid but more often presents as a painless lump without redness. They are more common on the upper eyelid but can appear on the lower eyelids too.
Treatment for Styes and Chalazia
Your stye or chalazion will resolve on its own without intervention. Oral antibiotics are not necessary as the drug doesn’t reach these lid lesions in any useful concentration. Instead, applying warm compresses several times a day can help the body to clear the clogged gland more quickly.
However, if the bacterial infection associated with a stye progresses to an infection of the surrounding tissues, known as preseptal cellulitis, this will require antibiotic treatment.
Never try to pop these eyelid lesions, as it can result in scarring or a secondary infection.
In some cases, a chalazion can hang around for months – if this becomes bothersome, you may choose to see an eye surgeon for surgical excision and drainage.
If you have a stye or chalazion, it’s a good idea to avoid wearing eye makeup and contact lenses as these can cause further irritation and prolong the healing process.
Other Common Eyelid Bumps
Skin tags are benign eyelid lesions more common in elderly patients. They appear as small growths on the skin attached by a tiny stalk. Skin tags can vary in colour and size, and even texture.
Seborrheic keratosis is a discoloured, wart-like bump also more common in older patients. Like a skin tag, it’s not necessary to treat seborrheic keratosis unless it bothers you for cosmetic reasons.
Milia are tiny white bumps on the eyelid skin and cheeks. These are cysts that form due to dead cells trapped under the surface of the skin. These tiny white bumps are common in infants and children.
Molluscum contagiosum is caused by a viral infection, most commonly in children. Typically, this viral wart appears only around one eye and can be contagious through physical contact. It’s generally safe to let it resolve on its own over weeks, but you should exercise impeccable hygiene to avoid transmitting the virus to others.
Squamous papilloma is a very common benign tumour, often found in middle-aged or older adults. It appears as a skin-coloured growth on the eyelids and doesn’t need any treatment.
Eyelid Bumps and Malignant Lesions
Though most lid bumps are benign lesions, it is possible to develop malignant eyelid tumours as well. To the untrained eye, it can be difficult to determine whether an eyelid bump is a malignant lesion or not. For this reason, even if you suspect your eyelid bump is just a stye or a chalazion, any new bumps should be checked by an optometrist or eye specialist for accurate diagnosis. This is especially true if the eyelid bump bleeds, is flaky or scaly, disrupts your eyelash line, or continues to grow over time.
Basal Cell Carcinomas
Basal cell carcinoma is the most common malignant lesion found on the eyelids, representing about 90% of eyelid malignancies. It’s most frequently found on the lower eyelid and in individuals with fair skin but can happen with any skin complexion.
Treatment is always recommended, as cancer cells can spread. Treatment modalities include using topical medications, though this is not as effective as complete excision with an eye surgeon specialising in oculoplastics.
Squamous Cell Carcinoma
Squamous cell carcinoma is much rarer than basal cell carcinoma. Still, it tends to spread more aggressively, including orbital invasion (of the eye socket) and distant metastasis to regional lymph nodes or parts of the body further away from the eye.
The treatment of choice is to have the lesion completely surgically removed, such as with a technique known as Mohs micrographic surgery.
Sebaceous Cell Carcinomas
This type of cancer arises from an oil gland of the eye, such as a meibomian gland. Sebaceous cell carcinomas can also spread aggressively and must be treated promptly.
Risk Factors for Lid Malignant Lesions
Understanding your risk for skin cancer can help you to respond more quickly if you notice a suspicious lesion around your eyelids.
Factors that increase your chances of developing a malignant eyelid bump include:
- Fair or light complexion
- Older age
- Ultraviolet exposure
- Certain viruses, such as HIV
- Skin conditions involving damage, such as from old burns or previous scarring
Though most lid lesions are harmless, any bump that is new and unusual should be checked out by a qualified eye care professional by calling on (03) 9070 5753. You may require monitoring over time for changes, or if the lesion exhibits obviously suspicious features of malignant transformation, prompt treatment may be needed.
Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.
Eyelid lesions in general practice