1. Molluscum contagiosum
BENIGN EYELID LESIONS
1. Nodules
Chalazion
Acute hordeola
Molluscum contagiosum
Xanthelasma
2. Cysts
Cyst of Moll
Cyst of Zeiss
Sebaceous cyst
Hidrocystoma
3. Tumours
Viral wart
Keratoacanthoma
Naevi
Capillary haemangioma
Port-wine stain
Pyogenic granuloma
Cutaneous horn

2. Signs of chalazion (meibomian cyst)
Painless, roundish, firm lesion
within tarsal plate
May rupture through conjunctiva
and cause granuloma

3. Histology of chalazion
Epithelioid Multinucleated
cells giant cells
Multiple, round spaces previously
containing fat with surrounding
granulomatous inflammation

4. Treatment of chalazion
Injection of local anaesthetic
Insertion of clamp
Incision and curettage

5. Acute hordeola Internal hordeolum External hordeolum (stye)
( acute chalazion )
External hordeolum (stye)
Staph. abscess of meibomian
glands
Staph. abscess of lash follicle and
associated gland of Zeis or Moll
Tender swelling within tarsal plate
Tender swelling at lid margin
May discharge through skin
or conjunctiva
May discharge through skin

6. Molluscum contagiosum
Signs
Complications
Painless, waxy, umbilicated nodule
Chronic follicular conjunctivitis
May be multiple in AIDS patients
Occasionally superficial keratitis

7. Histology of molluscum contagiosum
Lobules of hyperplastic epithelium
Intracytoplasmic (Henderson-Patterson)
inclusion bodies
Circumscribed lesion
Surface covered by normal
epithelium except in centre
Deep within lesion bodies are small and
eosinophilic
Near surface bodies are larger and
basophilic

8. Xanthelasma Common in elderly or those with hypercholesterolaemia
Yellowish, subcutaneous plaques
containing cholesterol and lipid
Usually bilateral and located medially

9. Eyelid cysts Eccrine sweat gland hidrocystoma Cyst of Moll
Translucent
On anterior lid
margin
Similar to cyst of Moll
Not confined to lid
margin
Cyst of Zeis
Sebaceous cyst
Opaque
On anterior lid
margin
Cheesy contents
Frequently at
inner canthus

10. Viral wart (squamous cell papilloma)
Most common benign lid tumour
Raspberry-like surface
Pedunculated
Sessile

11. Histology of viral wart
Finger-like projections of
fibrovascular connective tissue
Epidermis shows acanthosis (increased
thickness) and hyperkeratosis
Rete ridges are elongated and bent inwards

12. Keratoses Seborrhoeic Actinic Common in elderly
Affects elderly, fair-skinned individuals
Discrete, greasy, brown lesion
Most common pre-malignant skin lesion
Friable verrucous surface
Rare on eyelids
Flat ‘stuck-on’ appearance
Flat, scaly, hyperkeratotic lesion

13. Keratoacanthoma Lesion above surface epithelium
Uncommon, fast growing nodule
Acquires rolled edges and keratin-filled
crater
Central keratin-filled crater
Involutes spontaneously within 1 year
Chronic inflammatory cellular infiltration
of dermis

14. Naevi Intradermal Junctional Compound
Appearance and classification determined by location within skin
Tend to become more pigmented at puberty
Intradermal
Junctional
Compound
Elevated
Flat, well-circumscribed
Has both intradermal
and junctional
components
May be non-pigmented
Pigmented
No malignant potential
Low malignant potential

15. Capillary haemangioma
Rare tumour which presents soon after birth
May be associated with intraorbital
extension
Starts as small, red lesion, most frequently
on upper lid
Grows quickly during first year
Begins to involute spontaneously
during second year
Blanches with pressure and swells on crying

16. Periocular haemangioma
Treatment options
Steroid injection in
most cases
Surgical resection in
selected cases
Occasional systemic
associations
High-out heart failure
Kasabach-Merritt syndrome -
thrombocytopenia, anaemia
and reduced coagulant factors
Maffuci syndrome - skin
haemangiomas,
endrochondromas and
bowing of long bones

17. Histology of capillary haemangioma
Lobules of capillaries Fine fibrous septae
Lobules under high magnification

18. Port-wine stain (naevus flammeus)
Rare, congenital subcutaneous lesion
Segmental and usually unilateral
Does not blanch with pressure
Associations
Ipsilateral glaucoma in 30%
Sturge-Weber or
Klippel-Trenaunay-Weber
syndrome in 5%

19. Progression of port-wine stain
Initially red and flat
Subsequent darkening
and hypertrophy of skin
Skin becomes coarse,
nodular and friable

20. Pyogenic granuloma Cutaneous horn
Usually antedated by surgery or trauma
Uncommon, horn-like lesion protruding
through skin
Fast-growing pinkish, pedunculated or
sessile mass
May be associated with underlying actinic
keratosis or squamous cell carcinoma
Bleeds easily