Practice 10-Minute Consultation

Eyelid lumps and lesions

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3029 (Published 19 May 2014) Cite this as: BMJ 2014;348:g3029
  1. Anjali Gupta, specialist trainee 2 ophthalmology1,
  2. Simon Stacey, general practitioner2,
  3. Kwesi N Amissah-Arthur, specialist trainee 7 ophthalmology1
  1. 1Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK
  2. 2Westrop Surgery, Highworth, Swindon SN6 7DN, UK
  1. Correspondence to: A Gupta Birmingham and Midland Eye Centre, Dudley Road, Birmingham, United Kingdom, B18 7QH anjaligupta{at}doctors.org.uk
  • Accepted 5 March 2014

A 65 year old roofer presents to his GP with a slow growing lower lid lump of several months duration. It is not tender but there is involvement of his lid margin.

What you should cover

Eyelid lumps have a variety of causes, ranging from innocuous cysts to malignant lesions. Although sinister pathology is rare, early identification and referral are essential to ensure a good outcome.

History

Is it chronic?—Chronic lesions include papillomas (viral warts), naevi, sebaceous cysts, and molluscum contagiosum. These all have the same appearance as elsewhere on the body. Molluscum near the lid margin can cause a persistent follicular conjunctivitis.

Chalazia (figure 1) are the commonest chronic eyelid lumps. They are caused by a blocked meibomian gland. Chalazia are entirely benign; however, it is important to be suspicious of a recurrent chalazion in the same position as this might represent a malignancy.

Fig 1 Lower lid chalazion of the left eye. The lid margin is not distorted and there is no madarosis (loss of eyelashes), suggesting a non-sinister lesion

Is it tender?—Tender eyelid lumps and lesions are often acute and associated with infection. Hordeolum externum (a stye) arises from a staphylococcal infection of a lash follicle, presenting as a tender, erythematous, pus filled lesion near the eyelid margin. Hordeolum internum (an infected chalazion, figure 2) presents similarly, but is located away from the lid margin.

Fig 2 Left upper lid internal hordeolum with limited cellulitis

Dacryocystitis (figure 3), an infection of the lacrimal sac caused by a blocked nasolacrimal duct, is another periocular tender swelling. It is located beneath …

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