BENIGN EYELID LESIONS 1. Nodules Chalazion Acute hordeola 2. Cysts Cyst of Moll Cyst of Zeiss...
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Transcript of BENIGN EYELID LESIONS 1. Nodules Chalazion Acute hordeola 2. Cysts Cyst of Moll Cyst of Zeiss...
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BENIGN EYELID LESIONS1. Nodules
• Chalazion
• Acute hordeola
2. Cysts
•
• Cyst of Moll• Cyst of Zeiss• Sebaceous cyst• Hidrocystoma
3. Tumours
Xanthelasma
• Viral wart• Keratoacanthoma• Naevi• Capillary haemangioma• Port-wine stain• Pyogenic granuloma• Cutaneous horn
Molluscum contagiosum•
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Signs of chalazion (meibomian cyst)
Painless, roundish, firm lesion within tarsal plate
May rupture through conjunctiva and cause granuloma
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Histology of chalazion
Multiple, round spaces previously containing fat with surrounding granulomatous inflammation
Epithelioid Multinucleated cells giant cells
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Treatment of chalazion
Injection of local anaesthetic Insertion of clamp Incision and curettage
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Acute hordeola
• Staph. abscess of meibomian glands
• Tender swelling within tarsal plate• May discharge through skin or conjunctiva
• Staph. abscess of lash follicle and associated gland of Zeis or Moll
• Tender swelling at lid margin
• May discharge through skin
Internal hordeolum ( acute chalazion )
External hordeolum (stye)
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Molluscum contagiosum
• Painless, waxy, umbilicated nodule • Chronic follicular conjunctivitis
• May be multiple in AIDS patients • Occasionally superficial keratitis
Signs Complications
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Histology of molluscum contagiosum
• Lobules of hyperplastic epithelium
• Circumscribed lesion• Surface covered by normal epithelium except in centre
• Intracytoplasmic (Henderson-Patterson) inclusion bodies• Deep within lesion bodies are small and eosinophilic• Near surface bodies are larger and basophilic
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Xanthelasma
• Usually bilateral and located medially
• Common in elderly or those with hypercholesterolaemia• Yellowish, subcutaneous plaques containing cholesterol and lipid
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• Translucent• On anterior lid margin
Cyst of Moll
• Similar to cyst of Moll • Not confined to lid margin
Eyelid cysts
• Opaque• On anterior lid margin
Cyst of Zeis
Eccrine sweat gland hidrocystoma
Sebaceous cyst
• Cheesy contents • Frequently at inner canthus
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Viral wart (squamous cell papilloma)• Most common benign lid tumour• Raspberry-like surface
Pedunculated Sessile
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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
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Seborrhoeic
• Common in elderly• Discrete, greasy, brown lesion• Friable verrucous surface• Flat ‘stuck-on’ appearance
Actinic
• Most common pre-malignant skin lesion• Rare on eyelids
• Affects elderly, fair-skinned individuals
• Flat, scaly, hyperkeratotic lesion
Keratoses
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Keratoacanthoma
• Uncommon, fast growing nodule• Acquires rolled edges and keratin-filled crater
• Involutes spontaneously within 1 year
• Lesion above surface epithelium
• Central keratin-filled crater
• Chronic inflammatory cellular infiltration of dermis
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Naevi• Appearance and classification determined by location within skin• Tend to become more pigmented at puberty
• Elevated
Intradermal
• May be non-pigmented
• No malignant potential
• Flat, well-circumscribed
• Low malignant potential
Junctional
• Has both intradermal and junctional components
Compound
• Pigmented
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Capillary haemangioma
• Rare tumour which presents soon after birth
• Starts as small, red lesion, most frequently on upper lid
• Blanches with pressure and swells on crying
• Grows quickly during first year
• May be associated with intraorbital extension
• Begins to involute spontaneously during second year
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Periocular haemangioma
• Steroid injection in most cases• Surgical resection in selected cases
• High-out heart failure
Treatment options
Occasional systemic associations
• Kasabach-Merritt syndrome - thrombocytopenia, anaemia and reduced coagulant factors
• Maffuci syndrome - skin haemangiomas, endrochondromas and bowing of long bones
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Histology of capillary haemangioma
Lobules of capillaries Fine fibrous septae Lobules under high magnification
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Port-wine stain (naevus flammeus)
• Rare, congenital subcutaneous lesion
• Segmental and usually unilateral
• Does not blanch with pressure
• Ipsilateral glaucoma in 30%
• Sturge-Weber or Klippel-Trenaunay-Weber syndrome in 5%
Associations
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Progression of port-wine stain
Initially red and flat Subsequent darkening and hypertrophy of skin
Skin becomes coarse, nodular and friable
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Pyogenic granuloma
• Usually antedated by surgery or trauma• Fast-growing pinkish, pedunculated or sessile mass• Bleeds easily
Cutaneous horn
• Uncommon, horn-like lesion protruding through skin• May be associated with underlying actinic keratosis or squamous cell carcinoma