Lumps and bumps

• Mostest of the grossest
• Eyelid lesions and tumours
• E Kruger
• Glands


  • In caruncle and within eyebrow hairs
  • Sebaceous gland
  • Meibomian gland
  • Gland of Zeis
  • Glands of Moll
  • Endocrine sweat glands
  • Pilosebaceous units
• Sebaceous gland


  • Modified sebaceous glands in Tarsal plate
  • Single row of 20-30 orifices
  • Synthesize meibum which forms outer layer of tear film
• Meibomian gland


  • Modified sebaceous glands associated with lash folicles
• Gland of Zeis


  • Apocrine sweat glands
  • Open into a lash follicle or directly into anterior lid margin between lashes
  • More numerous in lower lid
• Glands of Moll


  • Throughout eyelid skin
  • Not confined to lid margin
• https://www.naturaleyecare.com/eye-conditions/meibomian-dysfunction/meibomian.png
• Self study
• Kanski pp 39
• Terminology


  • Clinical
  • Histological
  • Classification
  • Diagnosis
  • Treatment
• General considerations


  • Non-neoplastic lesions
  • Malignant lesions
• Non-neoplastic lesions


  • Non-cancerous, non-malignant or benign
  • Sterile vs infective
• Non-neoplastic lesions


  • Pathogenesis
  • Diagnosis
  • Symptoms
  • Signs
  • Treatment
• Chalazion (Meibomian cyst)


  • Chronic granulomatous inflammatory (small area of inflammation) lesion
  • Meibomian or Zeis glands
  • Lipid deposition or oil like substance
  • Surrounded by lipid-laden epithelioid cells, multinucleated giant cells and lymphocytes
  • Blepharitis usually involved
• Malignant lesions


  • Quality of tissue looks irregular
  • Changes are not consistent or predictable
  • Neovascular patterns around and within
  • Bleeding and ulceration of lesion
  • Uncharacteristically large lumps or bumps
• 15 20 % of periocular skin lesions are Benign lesions
• Benign lesions


  • Slow growing
  • Less inflamed
  • Shallow (not deep and invasive)
  • Well circumscribed
  • Usually, multiple lesions
• Chalazion


  • Blockage of meibomian glands (orifices) by sebaceous secretions
  • Caused by retention of normal secretions and granulomatous tissue formation
• Peanut butter stye...
• External hordeolum


  • Infection of eyelid glands of Zeiss or Moll
  • Caused by Staphylococcus aureus infection of sebaceous gland opening
• Internal hordeolum


  • Acute infection of meibomian gland
  • Chalazion with secondary infection with S Aureus
  • More chronic
  • More swollen than stye as tarsal glands are larger
  • NB! Be cautious of preseptal cellulitis
• Other cysts


  • Cyst of Zeiss
  • Cyst of Moll
  • Epidermal inclusion
  • Epidermoid
• Cyst of Zeiss


  • Small, non-translucent, obstruction of sebaceous gland ass with eyelash follicle
  • Contains oily secretions
• Cyst of Moll


  • Retention cyst of lid margin
  • Round, non-tender, translucent and fluid filled
• Epidermal inclusion


  • Implantation of epidermis into dermis following surgery
  • Slow growing, round and firm
• Epidermoid


  Developmental along embryonic lines of closure
• Epidermal inclusion cyst


  • Slow growing
  • Round and firm lesion
  • Common cutaneous lesions, often referred to as epidermoid, epidermal, inclusion or keratin cysts
  • Contain keratinized squamous epithelium and lipids, which may be odorous if ruptured
  • Eyelid lesions are usually solitary, mobile and less than 1 cm
  • May be congenital or may arise from trauma
• Xanthelasma


  • Common, bilateral
  • Affects middle-aged and elderly individuals
  • Hyperlipidaemia in 1/3 of cases
  • Intracellular fat
• Pyogenic granuloma


  • Most common acquired vascular lesion to involve the eyelids
  • Fast growing vascularized proliferation of granulation tissue
  • Fast growing, fleshy, red to pink mass which readily bleeds with minor contact
  • Usually occurs after trauma or surgery or it can be idiopathic
  • Painful
  • Differential diagnosis includes Kaposi sarcoma
  • Treatment can include use of steroid to reduce the inflammation or surgical excision at the base of the lesion
• Molluscum contagiosum


  • Common viral skin disease caused by a large (double stranded) DNA pox virus
  • Infection usually from direct contact in children and sexually transmitted in adults
  • Typical lesion appears as a raised, shiny, white to pink nodule with a central umbilication filled with cheesy material
  • Lesion is approximately 2mm to 3mm in diameter
  • May occur in clusters or groups, particularly in immunocompromised individuals
  • Eyelid lesions may produce a follicular conjunctival reaction
  • Usually spontaneously resolves 3 to 12 months but may be treated to prevent spread or if the lesion is close to the lid margin
  • Treatment: excision, cauterization, cryotherapy, laser
• Verruca Vulgaris


  • Common cutaneous wart caused by the epidermal infection of the human papillomavirus
  • More common in children and young adults and may occur anywhere on the skin
  • Lesions appear elevated with an irregular, hyperkeratotic papillomatous surface
  • Lesions along lid margin may cause papillary conjunctivitis
  • Tend to be self limiting but if treatment required cryotherapy or surgical excision
• Squamous cell papilloma


  • Fibrovascular tissue covered by hyperkeratotic squamous epithelium
  • Common benign with range of clinical appearance
  • Incidence increases with age
  • Some cases involve human papilloma virus
  • Treatment: excision or cryotherapy
• Seborrheic keratosis / Basal cell papilloma


  • Slow growing lesion
  • 'stuck on' appearance
  • Numerous
  • Differential diagnosis: pigmented basal cell carcinoma, naevus, melanoma
  • Treatment: excision, laser ablation, cryotherapy
• Actinic keratosis


  • Yellowish rough and crusty lesions that tend to bleed easily
  • Pre-malignant: may lead to squamous cell carcinoma
  • Cause: overexposure to the sun
  • Similar look to sebaceous keratosis but looks more greasier that actinic lesions
  • Treatment: Prompt excision = immediate referral
• Benign pigmented lesions


  • Nevus (Freckle)
  • Congenital melanocytic nevus
  • Intradermal nevus
  • Junctional nevus
  • Compound nevus
  • Strawberry nevus
  • Port-wine stain / Nevus Flammeus
  • Neurofibroma
• Nevus (Freckle)


  • Small brown macule (1-5 mm)
  • Increased melanin in the epidermal basal layer
  • Sun-exposed skin
  • Can regress completely
• Congenital melanocytic nevus


  • Small and uniform in colour
  • Kissing or split nevus – upper and lower lid
  • May contain numerous hairs
  • Large lesions have the potential for malignancy
• Intradermal nevus


  • Most common
  • Older patients
  • Papillomatous lesion with little pigment
  • Confined to dermis with no malignant potential