Eyelid Lumps, Bumps, Cysts, Styes and Cancers

By far the most common lesion of the eyelid is a chalazion, a benign lesion which often self resolves. Despite this, it is important that a qualified doctor with the correct equipment examines the lump to make a proper diagnosis because:
-Some lumps may be cancerous and require early surgery, e.g. Basal Cell Carcinoma. If this is the case, the earlier surgery is performed, the less disfiguring it is likely to be.
-Some lumps may be sight or even life threatening e.g. sebaceous gland carcinoma or squamous cell carcinoma. Prompt treatment may have an effect on improving the patient’s life expectancy.
-Some lumps may indicate a generalised illness. For example Xanthelasma may indicate dangerously high cholesterol levels.
-Some lumps may impair vision. Impairment of vision in young children may lead to poor development of vision and long term vision problems.

Eyelid Cysts, Styes, Chalazia, Benign Eyelid Lumps

Within the tough cartilage like structure of the back half of the eyelid (known as the tarsal plate) are numerous meibomian glands whose job it is to secrete a fine oily secretion on to the surface of the eye to help lubricate it.
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Chalazion: Note the firm swelling of the eyelid. This is occasionally associated with redness and discomfort
Chalazion: When the eyelid is everted one can see the inflammatory swelling arising from the cartilage like structure on the back of the eyelid

Sometimes the duct of a gland can become blocked leading to retention of the oil secretion within the gland. The gland enlarges and becomes tender as it becomes inflamed. The patient complains of a red, tender lump of the eyelid. A chalazion (meibomian cyst, internal hordeolum) represents an inflammatory reaction against the retained oil secretion, (mebum) of the meibomian glands. Eventually the inflammation settles resulting in a painless hard lump.

The patient may notice blurring of vision if the lump is particularly large causing distortion in the normal shape of the cornea.
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Typical acutely inflamed chalazion. Most chalazia resolve spontaneously although some enlarge so much as to burst either through the front or back of the eyelid

The vast majority of chalazia will settle down by themselves but hot compresses, using a towel soaked in hot water or proprietary microwaveable beanbags, often aids self resolution

Persistent chalazia can be drained with a simple operation where a small cut is made in the enlarged gland through the back surface of the eyelid and the retained oil secretions are removed.

Chalazia which develop repeatedly may result from chronic inflammation of the meibomian glands (blepharitis).

However, lumps which look like eyelid cysts which develop repeatedly in the same area of the eyelid despite surgery to remove them may signify something more sinister e.g. sebaceous gland carcinoma. Urgent referral to an oculoplastic surgeon is recommended to biopsy the lump.

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Stye of the upper eyelid. This is due to an acute infection affecting the roots of the eyelashes.
Although the terms chalazion, stye and cyst are often used interchangeably, even by doctors, to describe the same thing-i.e. some sort of cyst of the eyelid; the term stye actually describes an infection of the follicle of the eyelash.
The patient often complains of red tender swelling of the margin of the eyelid. More commonly, styes have a small yellow head of pus.
Like chalazia, hot compresses can help their resolution.
Uncommonly, persistent styes may require surgery which consists of a simple incision into the stye itself under local anaesthesia.

Other cysts, skin tags, milia
The skin of the eyelid contains numerous sweat secreting glands and oil secreting glands. Blockage of the openings of these glands leads to the retention of their secretion and the formation of cysts.

  • Blocked sweat glands lead to clear fluid containing cysts e.g. Cyst of Moll, Hydrocystoma
  • Blocked oil producing glands lead to white cysts. e.g. cysts of Zeiss

Benign cysts are not dangerous and only require removal if they represent a cosmetic or functional issue.

It is however recommended that all patients with any lesion of their eyelid seek a consultation with an ophthalmologist as some eyelid cancers may present in a similar fashion.

Eyelid Skin Tag
Skin Tag/ Viral Wart: These benign lesions require removal when they obstruct vision.
Large eyelid sebaceous cyst
Some sebaceous cysts can grow quite large. Careful removal is necessary to avoid scarring and collateral damage to local muscles and nerves
1 week post surgery:  The incisions blend away to become invisible.
Skin Tag/ Viral Wart
Skin Tag/ Viral Wart: These lesions are often removed as they represent a cosmetic nuisance.
Sebaceous cysts of the eyelids
Sebaceous of the eyelids: These are sometimes confused for xanthelasma/ cholesterol patches
2 weeks following surgery: Unlike xanthelasma, sebaceous cyst surgery is less complex and less risky.
Eyelid Milia
Eyelid Milia: These represent small blockages of the oil producing glands. Surgery often involves simple needle puncture and drainage.
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Sebaceous cysts: These white oil filled glands can enlarge to become a cosmetic nuisance
Surgery for their removal is quick and often done in the outpatient clinic
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Cyst of Zeiss: Oil filled cyst of the thin skin of the eyelid. Surgery is simple and can be done in an outpatient clinic
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Cyst of Zeiss of the upper eyelid: Oil filled cyst of the thin skin of the eyelid. Surgery is simple and can be done in an outpatient clinic.
Large cyst of Moll: These represent blocked sweat glands. Besides being a cosmetic nuisance, they sometimes enlarge greatly to interfere with eyelid closure
Large cyst of Moll: These represent blockage of the sweat glands. These can enlarge to interfere with function of the eyelid and become quite unsightly
Large cyst of Moll: Surgery for their removal is effective and often done under local anaesthetic.
Hydrocystoma/ Large Cyst of Moll
Some benign cysts enlarge to become a functional and cosmetic problem
1 week following surgery. The small skin fold smoothes out leaving no trace of surgery nor the original lump.