Eyelid lumps

Question 1

What is a chalazion?

Answer 1

• subacute/chronic sterile inflammatory lipogranuloma 2’ to blocked Meibomian gland & stagnation of sebaceous secretions
• Slow growing, hard, non-tender lump on inner eyelid

Question 2

what is chalazion associated with?

Answer 2

Meibomian gland dysfunction, seborrheic dermatitis

Question 3

what is the management of chalazion?

Answer 3

topical abx/steroid ointment, I&D (if large, pointing and boggy, or inadequate resolution w/ weeks of topical abx)

Question 4

what is internal hordeolum?

Answer 4

• Abscess 2’ acute Staph infection of Meibomian gland

- Acutely tender lump on inner eyelid

Question 5

what is the management of internal hordeolum?

Answer 5

topical/oral antibiotics, I&D

Question 6

what is external hordeolum?

Answer 6

• abscess 2’ acute Staph infection of a lash follicle (usually in children)
• Fast growing, acutely tender lump on lid margin

Question 7

what is the management of external hordeolum?

Answer 7

warm compresses, lash epilation

Question 8

what are the red flags of eyelid lumps?

Answer 8

• Bleeding
• Telangiectasia
• Irregular borders
• Distortion of eyelid architecture, e.g. loss of eyelashes
• Preauricular (+ submandibular, submental) lymphadenopathy
• Persistent/recurring lid lump

Question 9

Basal cell carcinoma (BCC)

• Most common eyelid malignancy, more commonly on the ___________
• Firm nodule, ___________ edges, fine telangiectasia, central ulceration (may mimic chronic blepharitis)
• Slow growing, locally invasive, rarely metastatic
• Risk factors: ________________

Answer 9

lower eyelid, medial canthus;

rolled pearly white;

elderly, Caucasian, chronic sunlight exposure

Question 10

Squamous cell carcinoma (SCC)

• Much less common than BCC
• will often occur on the _____________________
• _________ appearance, demonstrating the production of keratin
• Potentially more aggressive compared to BCC, high risk of metastasis (lymphatic or perineural spread)
• Hyperkeratotic with irregular margins (e.g. everted edges), telangiectasia less common vs BCC
• Risk factors: elderly, Caucasian, chronic sunlight exposure, ___________
• Management: ______________

Answer 10

upper eyelid and lateral canthus;

flaky

immunosuppression;

excisional biopsy, wide local excision (WLE)

Question 11

Sebaceous gland carcinoma
- Arises from \_\_\_\_\_\_\_\_\_\_\_\_\_\_
Uncommon
- Resembles chalazion or chronic blepharoconjunctivitis – suspect when there is \_\_\_\_\_\_\_\_\_\_\_\_, especially in elderly
Management:\_\_\_\_\_\_\_\_\_\_-

Answer 11

Meibomian and Zeiss glands;

chronic conjunctivitis or recurrent chalazion;

biopsy, wide local excision +/- cryotherapy