PRESENTED BY:

SINA MOTALLEBI

M.OPTOM (2 ND SEM)

AMITY MEDICAL SCHOOL

EYELID CYSTS

CONTENTS

Chalazion

Epidermoid cyst

Cyst of Zeis

Cyst of Moll

Eccrine hidrocystoma

Syringomas

Milia

Comedones

Chalazion

A chalazion(Meibomian cyst) is a chronic,sterile,granulomatous inflammatory lesion caused by retained sebaceous secretion leaking from the meibomian glands or other sebaceous glands into the adjacent stroma.

Diagnosis

Presentation is at any age with a gradually enlarging painless nodule.

Very occassionally a large upper lid chalazion may press over the cornea,induce astigmatism and cause blurred vsion

Signs

A non-tender,roundish,nodule within the tarsal plate.

Eversion of the lid may show an associated polypoidal granuloma if the lesion has ruptured through the tarsal conjunctiva.

A ‘marginal’ chalazion is similar except that it involves a gland of Zeis and is therefore located not in the tarsal plate but on the anterior lid margin.

Treatment

Treatment may not be required because about a third of chalazia resolve spontaneously and an internal hordeolum may discharge and disappear.

Persistent lesions maybe treated as follows:

1. Surgery: The eyelid is everted with a special clamp,the cyst is incised vertically and its contents curreted through the tarsal plate.

2. Steroid injection into the lesion is preferred for lesions close to the lacrimal punctum because of the risk of damage.

Between 0.1-0.2ml triameinolone diacetateaqueous solution diluted with lignocaine to a concentration of 5mg/ml is injected through the conjunctiva into the tissue around the lesion.

The success rate following one injection is 80%.

There is little to distinguish between surgical drainage and steroid injection in terms of effect.

3. Systemic tetracycline maybe required as prophylaxis in patients with recurrent chalazia.

Epidermoid Cyst

Epidermoid (Keratinous) cysts are uncommon.Theseare the result of implantation of surface epidermis during trauma or surgery.

Signs

Firm,round,mobile lesion which is superficial or sub cutaneous.

Rupture of the cyst may result in a foreign body reaction and secondary infection.

Treatment involves marsupialization or excision.

Miscellaneous cysts and nodules

1. Cyst of Zeis is a small,non-translucent cyst on the anterior lid margin.

2. Cyst of Moll is a small retention cyst that appears as a round,non-tender,translucent fluid-filled lesion on the anterior lid margin that may have a bluish tinge.

3. Eccrine hidrocystoma is less common but similar in appearance to a cyst of Moll except that it is usually located along the medial or lateral aspects and is close to but does not involve the lid margin itself.

4. Syringoma is a cellular proliferation of intraepidermal duct eccrine sweat gland epithelium.It is characterized by multiple,smallpapules.

5. Milia are caused by occlusion of pilosebaceousunits resulting in retention of keratin and represent tiny epidermoid cysts.They are characterized by tiny,white,round,superficial papules which tend to occur in crops.

Comedones occur in patients with acne vulgarisand consist of a plug of keratin and sebum within the dilated orifice of a hair follicle.They maybe either open(black heads) containing a plug of melanin-containing keratin or closed which are cream coloured papules.

References

Clinical Ophthalmology-Jack J. Kanski

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