Lumps & Bumps

LUMPS & BUMPS

Lumps and bumps can occur in different layers of the eyelid . It can be unsightly, uncomfortable ad occasionally painful. 

Depending on age, nature of presentation, the diagnosis can be varied and it is important to seek medical attention rather than performing self diagnosing and self medication.   The commonest benign eyelid lump is chalazion.  It usually located  near eyelid margin and is sometimes descried as white lump inside eye.  It usually occurs in young adult and sometimes improve just with warm compress.  Another common eyelid lump is epidermal cyst or sebaceous cyst which can be removed  easily.   Further away on a child, a lump near the brow is usually dermoid cyst which may grow in size with age.

While most are benign ( not cancerous), there are rare occasions that it can be dangerous, or sometime, life threatening, such as sebaceous cell carcinoma and melanoma.   Basal cell carcinoma can also occur especially on people with sun damaged skin.  The characteristics of malignant lessons including rapid growth, irregular margin, easy bleeding and destruction of normal eyelid structures. It is important to seek medical attention if you have any suspicious lesions.

TREATMENT

Except for chalazion which sometimes can be improved with warm compress, most lumps and bumps in the eyelid and periocular region will not go away unless surgery is done.  The surgery is best performed by oculoplastic surgeon who can not just remove the lesion without damaging other structures, but also able to reconstruct it back to its normal.  Otherwise issue such as droopy eyelid after chalazion removal may occur. 

In malignant /cancerous eyelid lesion such as basal cell carcinoma and sebaceous cell carcinoma, the lesion which is removed will be sent to histopathology laboratory to confirm that it is completely removed.  Afterwards a complex reconstruction which may involve flap or graft may be required to reconstruct the eyelid back.  Whilst the operation can be finished within a few hours, it may need a few months to get the eyelid to look back to normal again.  Therefore, it is very important for the patient or general ophthalmologist to refer to oculoplastic surgeon as early as possible as larger lesion will definitely take longer to recover.

This patient has right lower eylelid lump since young. However, the lump has been increasing in size for the past few months and hence patient come to seek help.

This patient has right lower eylelid lump since young. However, the lump has been increasing in size for the past few months and hence patient come to seek help.

The lump has been completely remove post op.

The lump has been completely remove post op.

Pre op: Persistent inflammation for months despite multiple steroid cream and treatment elsewhere.

Pre op: Persistent inflammation for months despite multiple steroid cream and treatment elsewhere.

Post surgery and steroid treatment: much improved and reduced inflammation

Post surgery and steroid treatment: much improved and reduced inflammation

Pre op: raised pigmented lesion warrant an investigative biopsy.

Pre op: raised pigmented lesion warrant an investigative biopsy.

Pre op: raised pigmented lesion warrant an investigative biopsy.

Post op:  Thankfully, biopsy showed benign naevus.  Patient recover well without much trace of previous intervention and  investigative biopsy.

Pre op: Left upper eyelid lump persisted despite three attempts of incision and curettage by general ophthalmologist.

Pre op: Left upper eyelid lump persisted despite three attempts of incision and curettage by general ophthalmologist.

Post op: After repair, left eyelid look satisfactory.

Post op: After repair, left eyelid look satisfactory.

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