Lumps and Bumps
(all photos are unaltered and show patients treated by Dr. Lee)
Chalazion, Stye, Hordeolum
Large oil glands called Meibomian glands are present along the edge of each eyelid. Their purpose is to secrete oil into the tear film to make it a better lubricant. Meibomian glands can be quite large—as long as 8 mm in the upper eyelids. When they become blocked, they may form collections called chalazia (singular chalazion), which are essentially over-sized pimples and may become disturbingly large.
A second type of collection (pimple) can form on the eyelid from one of the small oil glands at the roots of the eyelashes. These are located at the eyelash line, are smaller than chalazia, and are often called styes, but this is not a medical term and is not clearly defined.
When a chalazion becomes very inflamed or infected, it is called a hordeolum.
Most chalazia and styes resolve on their own, but may take weeks to months to do so. No pill, eyedrop, or ointment has been proven to make them go away faster. In some cases, applying hot compresses may help chalazia drain, which may help them resolve quicker. If a chalazion is completely walled off and not near to draining, it is unclear if hot compresses help, but there is no harm in trying them.
Hordeolum (inflamed chalazion)
Chalazion drainage procedure--
hurts very little (really!)
Sometimes the eyelid will simply wall off a chalazion with a layer of scar tissue, leaving a persistent nodule. Such a nodule can be emptied and flattened with a simple office procedure. While this procedure may seem frightening, if numbing injections are given gently, it actually hurts very little (and sometimes not at all). The procedure may leave the eyelid swollen and bruised, but this clears significantly within a couple of days. If the procedure is performed on a Friday, most patients (even appearance-conscious ones) are comfortable returning to work or school on Monday (although a bit of bruising and swelling may still be present).
Hidrocystoma (sweat gland cyst)
Sweat glands at the eyelash roots may become blocked for unclear reasons and form cysts of clear fluid. While not dangerous, these cysts will often continue to grow and may become unsightly or bothersome. If a cyst has been present for a long time, is not changing, and is typical in appearance, it does not have to be removed.
Hidrocystoma (sweat gland cyst)
There are three!
Simply puncturing and draining these cysts is not enough: they will usually close and refill with liquid. Permanent removal involves cutting off the top half of the cyst and destroying the remaining cyst lining with a hot wire (marsupialization). This is a small office procedure that hurts very little. It almost always heals beautifully with no scarring.
Hidrocystoma, immediately after marsupialization
(the biggest cyst was stitched closed, the other two cauterized)
Hidrocystoma, after removal and healing
A large hidrocystoma may require complete removal rather than destruction/marsupialization.
During this procedure, the entire cyst along with the skin on its upper half has been dissected away from eyelid. The skin will be stitched closed.
Large Hidrocystoma, complete excision
Large Hidrocystoma, 2 weeks after removal
This benign growth may enlarge slowly over time. Although it is not dangerous, it may become bothersome or unsightly. Sometimes, it may be hard to distinguish from a cancer. If it has been present for a long time, is not changing, and is typical in appearance, it does not have to be removed. Removal is a small office procedure that hurts very little and heals very well (often invisibly) in most cases.
Seborrheic Keratosis, after removal
Nevi (plural of nevus) are usually pigmented, but not always--some nevi are skin colored. Most nevi are benign, but, like nevi elsewhere on the body, may give rise to a cancer (melanoma). Benign nevi will often grow, and this does not mean they are cancerous. If a nevus has been present for a long time, is not changing, and has no suspicious features, it may be simply observed over time.
Nevus, after shave biopsy
Along the eyelid edge, enlarging nevi are typically shaved off flush with the surrounding eyelid. This is a small office procedure that hurts very little and almost always heals very well. The tissue removed is always sent to the pathology lab to confirm that the nevus is benign. Because the roots of the nevus are left behind, it may regrow slowly, typically over years (this does not mean it is cancerous).
If the nevus is very suspicious for cancer, or if a biopsy shows that it is cancerous, complete excision with stitches is necessary.
Nevi can develop anywhere, even over the mouth of the tear drainage duct (lacrimal punctum).
Nevus over lacrimal punctum
Removal/biopsy is performed the same way as elsewhere on the eyelid (albeit more delicately) and typically heals beautifully.
Nevus over lacrimal punctum, after shave biopsy
(note that lacrimal punctum is still open and functioning)
Verruca is the medical term for a wart. It is caused by a virus and may enlarge and spread. It is often itchy--scratching may spread the virus to other locations and cause more warts to grow. It is not dangerous, so if it is not bothersome, not spreading, and typical in appearance, it does not have to be removed. Removal, however, is usually advisable to prevent spread. It is a small office procedure that hurts very little and almost always results in no visible scar. After removal, it is possible for a verruca to regrow, but this is very rare.
Verruca (wart) at eyelash line
A hemangioma is a benign clump of blood vessels. If it has been present for a long time, is not changing, and is typical in appearance, it does not have to be removed. As with other eyelid growths, however, removal is a small office procedure that hurts very little and almost always results in no visible scar.
Hemangioma, after removal
Dacryops (lacrimal gland cyst)
The main lacrimal gland is a large tear gland located under the outer corner of the upper eyelid. It may sometimes form cysts of tear fluid. If typical in appearance, not growing, and not bothersome, such cysts may be left alone. Enlarging or bothersome cysts can be easily removed in the office with minimal, if any, pain.
Dacryops (lacrimal gland cyst)
As with sweat gland cysts, simply puncturing and draining a dacryops will not result in a permanent solution. To permanently remove one, the front half of the cyst must be removed and the cavity allowed to heal open so fluid cannot reaccumulate.