EYELID MALPOSITIONS

Eyelid malignancies may present as eyelid malpositions. Patients with basal cell carcinoma may be initially diagnosed as ectropion, entropion, ptosis, or eyelid retraction (27–32).

CONJUNCTIVAL LESIONS

Benign cysts may occur on the conjunctival surface of the eyelid. They are usually filled with a clear fluid. Sometimes there is a calcium deposit or a granulomatous substance within the cyst.

Papillomatous growths tend to be pedunculated when they arise at the lid margin, but they can sometimes be sessile. The majority of papillomas are infectious or irritative in origin with no malignant potential, but, in some cases, a squamous cell carcinoma appears as a papilloma. Squamous cell carcinomas can also appear as a fleshy mass on the conjunctival surface of the eyelid (33).

The conjunctiva may be involved by vascular tumors. These may vary in size but are usually clumps of dilated vessels. Care must be taken that the visible vasculature on the eyelid is not an extension of an orbital tumor or of an orbital varix. Hemangiomas, lymphangiomas, and varices may present as vascular tumors on the conjunctival surface of the eyelid.

Vascular tumors of the eyelids are often manifestations of orbital tumors. These include capillary and cavernous hemangiomas, varices, and lymphangiomas. They may present as a bluish mass under the skin or a reddish mass in the conjunctiva (31, 32). Capillary hemangiomas of childhood often regress with time. Some should be treated if they are extensive and vision is compromised by severe ptosis. Cavernous hemangiomas may involve surrounding skin and surgical excision may be indicated.2

When evaluating an eyelid vascular tumor, care must be taken to see if there is orbital involvement. A capillary hemangioma that is localized to the skin can be excised but significant bleeding should be expected (34, 35).

RACE AND EYELID CANCER

Eyelid cancers occur in Caucasians, Asians, Hispanics, and Blacks. Since sun exposure is thought to be related to the incidence of these tumors, people with more melanin in the skin seem to be better protected. Blacks have a much lower incidence of skin cancer than Caucasians, but they do get basal cell carcinoma, squamous cell carcinoma, and melanoma. When melanoma occurs in Blacks, it is usually on the palms of the hands or soles of the feet. This, of course, suggests that the areas of less melanin in the skin

are more prone to develop the cancer. However, sun exposure is also a factor, and these areas would receive less sun exposure. All of the factors regarding causes of skin cancer are still not known. Basal cell carcinoma accounts for about 90% of eyelid skin cancers in the Western Hemisphere, but in Asia the incidence seems to be between 30 and 50%.3 Sebaceous cell carcinoma is much more common in Asia than in the West. It accounts for 20–40% of eyelid malignancies. Squamous cell carcinoma is less common and accounts for 10–20% of eyelid cancers, whereas malignant melanoma has an incidence of between 5 and 10% in various parts of China.3 It is important to consider eyelid malignancies when evaluating eyelid tumors in non-Caucasians.

References 13

REFERENCES

1.Older JJ (1979). Encysted corneal contact lens presenting as an eyelid mass. Ann. Ophthalmol., 11(9): 1393–1394.

2.Spencer WH (1986). Ophthalmic Pathology. An Atlas and Textbook. W.B. Saunders, Philadelphia, pp. 2237–2248.

3.Liu D, Zhao G, Xu N (1996). Eyelid Tumors. In: Priciples and Practice of Ophthalmic Plastic and Reconstructive Surgery. WB Saunders, Philadelphia, pp. 721–728.