Lids and Lashes (pt 4)

Potential Dx for “there is a bump on my eyelid”

• Chalazion (most common)

• Sebaceous cell carcinoma

• Cutaneous horn

• Pyogenic granuloma

• Keratoacanthoma

• Cyst

• Papilloma (2nd most common)

• Virus

Chalazion

Chronic sterile lipogranuloma caused by inflammation and obstruction of meibomian gland

Granulomatous inflammatory response to products of lipid breakdown leak into the lid tissue

Chalazion clinical findings

Painless nodule on the upper or lower lid

Chalazion complications

None other than cosmetic

Chalazion Tx

• Oral antibiotics (tetracycline or doxycycline) for anti-inflammatory properties

• Steroid injections (anti-inflammatory)

• Incision and drainage: Vertical incision to take out meibomian gland

Chalazion hallmark signs

Painless nodule within lid

Sebaceous cell carcinoma

Aggressive cancer of the sebaceous glands

Think this if chalazion keeps appearing in the same place

Sebaceous cell carcinoma risk factors

Elderly and UV exposure

Sebaceous cell carcinoma clinical findings

• Firm painless lid nodule usually on upper lid

• Thickening of the lid margin

• No improvement with chalazion or bleph Tx

Sebaceous cell carcinoma complications

5-10% mortality rate

Sebaceous cell carcinoma Tx

Surgical excision

Sebaceous cell carcinoma hallmark findings

Chronic chalazion or bleph that doesn’t resolve

Cutaneous horn

Protrusion of keratin from the lid, seen with a pre-existing condition

Can be benign, premalignant, or malignant

Cutaneous horn risk factors

Elderly male and UV exposure

Cutaneous horn clinical findings

Cone shaped protrusion commonly found on the upper lid near lateral canthus

Cutaneous horn complications

Can transition into squamous cell carcinoma (invasive)

Cutaneous horn Tx

Excision with biopsy

Cutaneous horn hallmark signs

Keratinized protrusion

Pyogenic granuloma

Benign non-cancerous growth of blood vessels, can be triggered by trauma or surgery

Pyogenic granuloma clinical findings

• Smooth bright red, pink, or purple polypoidal lesion that bleeds easily

• Pain

Pyogenic granuloma complications

Bleeding

Pyogenic granuloma Tx

Surgical excision

Pyogenic granuloma hallmark signs

Painful red, pink, purple polypoidal lesion

Keratoacanthoma

Fast growing tumor of the hair follicle

Keratoacanthoma risk factors

• Chronic UV exposure

• Previous skin injuries or trauma

• Immunocompromised

Keratoacanthoma clinical findings

Dome shaped, keratin filed center

Keratoacanthoma complications

Transformation into squamous cell carcinoma

Keratoacanthoma Tx

• Spontaneous resolution

• Surgical excision with biopsy

• Radiation

• Cryotherapy

Keratoacanthoma hallmark signs

Dome shaped keratin filled crater

Moll cyst

Gland affected: Apocrine

Hallmark signs: Round, translucent, on anterior lid margin

Zeis cyst

Gland affected: Sebaceous

Hallmark signs: Yellow, on anterior lid margin

Sebaceous cyst

Gland affected: Pilosebaceous

Hallmark signs: Yellow or white, at inner canthus

Milia cysts

Gland affected: Pilosebaceous

Hallmark signs: White round papules that occur in groups

Eccrine hidrocystoma

Gland affected: Eccrine (sweat)

Hallmark findings: Round, translucent, doesn’t affect lid margin

What is the main differences between chalazions and cysts?

Chalazions: Deeper within lid, more Txs

Cysts: Superficial, only Tx is observation

Squamous cell papilloma

Skin tag, benign growth of the lid caused by proliferation of squamous epithelium overlaying a vascular core

Squamous cell papilloma clinical findings

• Soft round skin colored lesion

• Pedunculated (stalk) or sessile (flat) base

Squamous cell papilloma complications

Ocular irritation

Squamous cell papilloma Tx

Observation

Excision for cosmetics or too large in size

Squamous cell papilloma hallmark signs

Soft, pedunculate or sessile base

Verruca Vulgaris (viral wart)

Benign viral growth on the lid margin caused by human papillomavirus

Verruca Vulgaris clinical findings

Skin colored, waxy growth with finger like/scalloped projections

Verruca Vulgaris complications

Follicular conjunctivitis

Verruca Vulgaris Tx

Excision

Verruca Vulgaris hallmark signs

Scalloped edges

Molluscum contagiosum

Viral infection of the skin caused by molluscum contagiosum poxvirus

Molluscum contagiosum clinical findings

• Pale waxy umbilicated nodule on lid margin

• Can be seen in isolation (kids) or in groups (immunocompromised)

• Discharge that contain infected degenerate cells

Molluscum contagiosum complications

Follicular conjunctivitis

Molluscum contagiosum Tx

Spontaneous resolution or excision

Molluscum contagiosum hallmark signs

Waxy umbilicated nodule, cauliflower appearance