A wide range of benign tumours, cysts and blocked glands can form on the eyelids. Benign tumours are abnormal growths, but in general they do not invade or damage the surrounding tissue and therefore are not dangerous in the same way as malignant tumours, which invade the surrounding tissue and sometimes can spread around the body. Cysts and blocked glands are fluid filled lumps under the eyelid skin that generally form the glands that produce sweat or part of the tears.
Although these benign eyelid lesions do not generally cause damage to the surrounding tissue and certainly do not spread around the body, they can cause symptoms and therefore surgical removal may be appropriate and it is often important to remove them to ensure that they are not malignant (cancerous).
What symptoms can benign eyelid lesions cause?
- Irritation: benign eyelid lesions can cause a feeling of irritation around the eye
- Pressure: blocked glands can cause a feeling of pressure because of the build up of fluid in the cyst
- Cosmetic: benign eyelid lesions can be unsightly, particularly as the eyes and eyelids are highly visible parts of our body.
- Visual symptoms: large lesions or lesions that hang over the edge of the eyelid (such as skin tags) can get in the way of our vision. Some lesions can also exert slight pressure on the eye ball which can cause astigmatism which temporarily reduces vision
- Uncertainty and anxiety: sometimes it can be impossible to know if a lesion is benign or malignant. Therefore, removal may be preferred so that the lesion can be examined in the laboratory (histopathological examination) to determine exactly what it is. If it is a benign lesion this is very reassuring and if it is a malignant lesion a more extensive excision can be planned.
How are benign eyelid lesions removed?
Benign lesions are almost always removed surgically. This is usually a very minor daycase procedure. After a clinic assessment of the lesion, local anaesthetic eyedrops are instilled into the eye and local anaesthetic is injected into the skin around the lesion. The lesion is excised and sometimes a few small stitches are required to close the incision. You may have an eyepatch and some antibiotic cream to take home depending on the lesion and the surgery. Most lesions are sent for examination in the laboratory (histopathology) to be certain that they are benign.
It is almost always possible to remove the lesions so as not to leave a visible scar.
Malignant skin tumours commonly occur in the eyelid. The most common types of malignant eyelid skin tumours in Caucasians are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), but other rarer types include sebaceous gland carcinoma and melanoma. These cancers can all grow and invade surrounding tissues, which can be very damaging to the eye and eye socket. Very occasionally, some of them can also spread around the body (metastasise), which can be fatal.
BCCs hardly ever spread to other parts of the body, and only ever do so when very they are left to get very large but they can cause significant damage to the eyelids and eye socket. SCCs may spread if they are left too long before treatment. Sebaceous gland carcinomas and melanomas have a higher chance of spreading if they are not treated when they are small.
Skin cancers should to be removed. This is normally done surgically (excised), although occasionally other treatments like radiotherapy and chemotherapy are also used. The whole tumour and a surrounding ring of healthy tissue (a margin) should be excised. The excised sample is sent to the pathology laboratory to be examined under a microscope to confirm exactly what type of tumour it is and if the whole tumour has been removed.