Lid Trauma and Tumors

Question 1

Contusion

Answer 1

• ecchymosis
• black eye, self-limiting
• IOP can spike if hemorrhage, sight threatening
• urgent cases must be treated with surgery

Question 2

Thermal Burn

Answer 2

• flame, flash, scalding
• supportive treatment; 3rd degree requires consult
• edema can result, sight threatening

Question 3

Chemical Burn

Answer 3

• acid is self-limiting
• alkali can be extremely destructive, lead to capillary closure
• white eye is VERY bad sign
• Tx immediate profuse irrigation (use pH test to determine when neutral); followed by antibiotic and cycloplegia
• increased severity= worsening corneal haze and non-perfusion

Question 4

Adhesive

Answer 4

• crazy glue on lids; more aggravating than dangerous

- Tx: mineral soak, pressure patch, forceps removal after 24h

Question 5

Molluscum contagiosum

Answer 5

• benign cyst, viral skin infection
• multiple yellow nodules, concurrent follicular conjunctivitis, SPK
• Tx: excision followed by cautery to reduce spread

Question 6

Xanthelasma

Answer 6

• plague-like lipid lesion, benign
• occurs most in female middle aged patients
• hyperlipidemia seen in younger affected patients
• excision for cosmesis purposes
• typically bilateral and medially located

Question 7

Seborrheic Keratoses (papilloma)

Answer 7

• common in elderly, well-demarcated lesion, irregular surface
• dark in color, discrete and greasy
• flat, stuck on appearance
• benign

Question 8

Actinic Keratoses (AK)

Answer 8

• pre-cancerous lesion (can give rise to SCC)
• seen most in elderly fair-skinned (UV exposure)
• most seen at top of ears
• flat scaly reddish, hyperkeratotic lesion
• Tx: biopsy with cryo

Question 9

Sudoriferous Cyst

Answer 9

• formed from Gland of Moll, clear round nodule (up to 4mm)
• asymptomatic, but can lead to trichiasis (w/ complaints of irritation)
• Tx: excision (lancing can increase reoccurrence)

Question 10

Sebaceous Cyst

Answer 10

• occurs at hair follicles or sebaceous glands
• depending on their depth they can be white/creme colored
• asymptomatic
• Tx: if superficial lance; if subcutaneous excise

Question 11

Verrucae

Answer 11

• caused by HPV; a viral wart
• most common benign tumor on lids
• Vulgaris: clustered on a stalk
• Plana: flat, pitted appearance
• Tx: chemical cautery (if drained, can release virus and cause conjunctivitis)

Question 12

Basal cell carcinoma

Answer 12

• most common malignant eyelid tumor
• slow growing, usually on lower lid
• erodes away locally, has pearly boreders
• may develop central ulceration sclerosing form (indistinct edges)
• Tx: excise, biopsy, radiation

Question 13

Squamous cell carcinoma

Answer 13

• 5 to 10% of lid malignancies
• more aggressive than BCC, greater potential to metastasize
• lower lid, affects elderly patients with fair skin, UV exposure
• arises from pre-existing actinic keratoses (or de novo)
• appears benign, scaly, plaque like, nodular, and ulcerating

Question 14

Sebaceous Gland (carcinoma)

Answer 14

• very rare; aggressive with 10% mortality
• forms from meibomian glands; can present as reoccurring chalazion
• prefers upper lid; can invade conj and mimic chronic conjunctivitis
• may be good biopsy excised chalazion to rule out

Question 15

Melanoma

Answer 15

• rare

- melanotic (abnormal deposits of melanin) or amelanotic (50%)

Question 16

Kaposi’ sarcoma

Answer 16

• vascular tumor associated with AIDS (associated with advanced disease)
• pink to brown, rapid growing and tends to bleed
• Tx: radiation (very sensitive to radiotherapy)