Swellings of the lids Meibomian cysts (chalazion)

Swellings of the lids Meibomian cysts (chalazion)

These are the most common lid swellings ( Figure 49.4 ). A meibomian cyst is a chronic granulomatous inflammation of a meibomian gland. It may occur on either upper or lower lids and presents as a smooth, painless swelling. It can be felt by rolling the cyst on the tarsal plate. It can be distinguished from a stye (hordeolum), which is an infection of a hair follicle and is usually painful. Persistent meibomian cysts that do not resolve with conservative treatment (hot compresses) are treated by incision and curettage from the conjunctival surface. Styes are treated by antibiotics and local heat. Basal cell carcinoma (rodent ulcer) This is the most common malignant tumour of the eyelids ( Figure 49.5 ). Basal cell carcinomas may be locally invasive but do not tend to metastasise. They are more common on the lower lids, often start as a small pimple that ulcerates and has raised edges (‘rodent ulcer’) and are usually easily excised in the early stages. Histological confirmation that the excision is complete is required. More extensive lesions may require specialist techniques such as Mohs’ micrographic surgical excision controlled by frozen section. Local radiotherapy or cryotherapy can be carried out; however, recurrence is more common, more aggressive and more di ffi cult to detect. Frederic E Mohs , 1910–2002, developed the technique of micrographic surgical excision while a medical student at University of Wisconsin, USA. Jacob Antonius Moll , 1832–1913, ophthalmologist of The Hague, The Netherlands. Eduard Zeis , 1807–1868, Professor of Surgery , Marburg (1844–1850), who later worked at Dresden, Germany , described these glands in 1835. Basal cell carcinomas /uni25CF /uni25CF /uni25CF

Figure 49.4 Meibomian cyst (courtesy of Mr D Spalton, FRCS). Figure 49.5 Rodent ulcers (courtesy of Mr J Beare, FRCS). Basal cell carcinomas are the most common malignant eyelid tumour Treatment is by wide local excision with careful histopathological margin control All unusual eyelid lesions (especially in the elderly) should be biopsied

Swellings of the lids Meibomian cysts (chalazion)

These are the most common lid swellings ( Figure 49.4 ). A meibomian cyst is a chronic granulomatous inflammation of a meibomian gland. It may occur on either upper or lower lids and presents as a smooth, painless swelling. It can be felt by rolling the cyst on the tarsal plate. It can be distinguished from a stye (hordeolum), which is an infection of a hair follicle and is usually painful. Persistent meibomian cysts that do not resolve with conservative treatment (hot compresses) are treated by incision and curettage from the conjunctival surface. Styes are treated by antibiotics and local heat. Basal cell carcinoma (rodent ulcer) This is the most common malignant tumour of the eyelids ( Figure 49.5 ). Basal cell carcinomas may be locally invasive but do not tend to metastasise. They are more common on the lower lids, often start as a small pimple that ulcerates and has raised edges (‘rodent ulcer’) and are usually easily excised in the early stages. Histological confirmation that the excision is complete is required. More extensive lesions may require specialist techniques such as Mohs’ micrographic surgical excision controlled by frozen section. Local radiotherapy or cryotherapy can be carried out; however, recurrence is more common, more aggressive and more di ffi cult to detect. Frederic E Mohs , 1910–2002, developed the technique of micrographic surgical excision while a medical student at University of Wisconsin, USA. Jacob Antonius Moll , 1832–1913, ophthalmologist of The Hague, The Netherlands. Eduard Zeis , 1807–1868, Professor of Surgery , Marburg (1844–1850), who later worked at Dresden, Germany , described these glands in 1835. Basal cell carcinomas /uni25CF /uni25CF /uni25CF

Figure 49.4 Meibomian cyst (courtesy of Mr D Spalton, FRCS). Figure 49.5 Rodent ulcers (courtesy of Mr J Beare, FRCS). Basal cell carcinomas are the most common malignant eyelid tumour Treatment is by wide local excision with careful histopathological margin control All unusual eyelid lesions (especially in the elderly) should be biopsied

Swellings of the lids Meibomian cysts (chalazion)

These are the most common lid swellings ( Figure 49.4 ). A meibomian cyst is a chronic granulomatous inflammation of a meibomian gland. It may occur on either upper or lower lids and presents as a smooth, painless swelling. It can be felt by rolling the cyst on the tarsal plate. It can be distinguished from a stye (hordeolum), which is an infection of a hair follicle and is usually painful. Persistent meibomian cysts that do not resolve with conservative treatment (hot compresses) are treated by incision and curettage from the conjunctival surface. Styes are treated by antibiotics and local heat. Basal cell carcinoma (rodent ulcer) This is the most common malignant tumour of the eyelids ( Figure 49.5 ). Basal cell carcinomas may be locally invasive but do not tend to metastasise. They are more common on the lower lids, often start as a small pimple that ulcerates and has raised edges (‘rodent ulcer’) and are usually easily excised in the early stages. Histological confirmation that the excision is complete is required. More extensive lesions may require specialist techniques such as Mohs’ micrographic surgical excision controlled by frozen section. Local radiotherapy or cryotherapy can be carried out; however, recurrence is more common, more aggressive and more di ffi cult to detect. Frederic E Mohs , 1910–2002, developed the technique of micrographic surgical excision while a medical student at University of Wisconsin, USA. Jacob Antonius Moll , 1832–1913, ophthalmologist of The Hague, The Netherlands. Eduard Zeis , 1807–1868, Professor of Surgery , Marburg (1844–1850), who later worked at Dresden, Germany , described these glands in 1835. Basal cell carcinomas /uni25CF /uni25CF /uni25CF

Figure 49.4 Meibomian cyst (courtesy of Mr D Spalton, FRCS). Figure 49.5 Rodent ulcers (courtesy of Mr J Beare, FRCS). Basal cell carcinomas are the most common malignant eyelid tumour Treatment is by wide local excision with careful histopathological margin control All unusual eyelid lesions (especially in the elderly) should be biopsied