Tumor of the eye lid

Tumors of the Eyelid

1. TUMOURS OF THE TUMOURS OF THE
LIDSLIDS
Dr. Christina SamuelDr. Christina Samuel

2. Common benign tumors of the lids Common benign tumors of the lids
A. CystsA. Cysts
Dermoid cyst Dermoid cyst
Sebaceous cystSebaceous cyst
Meibomian cyst Meibomian cyst
B. Tumors B. Tumors
- Naevus or mole - Naevus or mole
- Papilloma - Papilloma
- Hemangioma- Hemangioma
- Neuro fibroma - Neuro fibroma
- Granuloma - Granuloma
- Warts - Warts
- Xanthalosma - Xanthalosma
- Molascum contagiasm - Molascum contagiasm

3. Dermoid Dermoid
Presents since birth and came grow in to a large Presents since birth and came grow in to a large
size size
Typically found at the outer orbital margin but Typically found at the outer orbital margin but
may be else were also may be else were also
The tumor is fixed to the underlying bone – The tumor is fixed to the underlying bone –
zygomatico temporal suturezygomatico temporal suture
 the skin our the tumour is freely movable the skin our the tumour is freely movable

4. Treatment Treatment
Surgical excision to be removed intact Surgical excision to be removed intact
Cauterization Cauterization

5. Sebaceous cyst Sebaceous cyst
It looks like a dermoid It looks like a dermoid
TThe differentiating features from the dermoidhe differentiating features from the dermoid
The sebaceous cyst is not attached firmly to the The sebaceous cyst is not attached firmly to the
underlying structures. But freely movable underlying structures. But freely movable
A pigmented point on the skin were the skin is A pigmented point on the skin were the skin is
adherent to the underlying cyst adherent to the underlying cyst
Unlike a dermoid it can be present any were in the lid Unlike a dermoid it can be present any were in the lid
and is commonly seen at the inner port of the upper and is commonly seen at the inner port of the upper
eye lid eye lid

6. Naevous or mole Naevous or mole
Commonly seen at the muco cutaneous junction Commonly seen at the muco cutaneous junction
of the lid of the lid
It may affect either the skin or conjunctiva of It may affect either the skin or conjunctiva of
the lid the lid
It may undergo malignant transformation if It may undergo malignant transformation if
untreated untreated

7. Neuro fibroma Neuro fibroma
Multiple pedunculated growth of varying may be Multiple pedunculated growth of varying may be
seen on the skin of the lid seen on the skin of the lid
It may be seen on the eye lid as a part of It may be seen on the eye lid as a part of
generalised neuro fibrofibrometosis (Von generalised neuro fibrofibrometosis (Von
reckling hausen’s diseases) reckling hausen’s diseases)
It may cause mechanical ptosisIt may cause mechanical ptosis
Small multiple tumor are distributed along the Small multiple tumor are distributed along the
hyper trophied nerves hyper trophied nerves

8. Papilloma (sqamous papilloma) Papilloma (sqamous papilloma)
It is the most common benign tumor of the eye lid It is the most common benign tumor of the eye lid
It affects patients older then 30 yrs due to exposure to It affects patients older then 30 yrs due to exposure to
Ultra violet rays Ultra violet rays
It may present as a round multi lobular lesion with a It may present as a round multi lobular lesion with a
central vascular core central vascular core
Treatment:Treatment:
Electrocautery Electrocautery
Chemical caterization Chemical caterization
CoCo
22 laser ablation laser ablation

9. Hemangioma Hemangioma
There are two types There are two types
Capillary hemangioma Capillary hemangioma
Manifests as bright red or portwine spots – Manifests as bright red or portwine spots –
composed of dilated capillaries composed of dilated capillaries
Cavernous hemagioma Cavernous hemagioma
Manifests as large dilated and anastomosing Manifests as large dilated and anastomosing
subcutaneous venous channels with are blue in subcutaneous venous channels with are blue in
colour colour

10. In general In general
Hemangiomas are found along the distribution Hemangiomas are found along the distribution
of first and second divisions are the trigeminal of first and second divisions are the trigeminal
nerve nerve
Hemangiomas of the lid is often associated Hemangiomas of the lid is often associated
hemangioma of the coroid, leptomeninges and hemangioma of the coroid, leptomeninges and
hydrophthalmos (Sturge-weber syndrome) hydrophthalmos (Sturge-weber syndrome)

11. Treatment Treatment
Small hemangioma – Spontaneous involution Small hemangioma – Spontaneous involution
Large hemangiomasLarge hemangiomas
Intra lesion injection of a mixture of 40mg of Intra lesion injection of a mixture of 40mg of
triamcinolone acetonide & 6mg of beta methasone triamcinolone acetonide & 6mg of beta methasone
sodium phosphate sodium phosphate
Systemic Corticosteroids Systemic Corticosteroids
RadiotheraphyRadiotheraphy
Surgical excision Surgical excision

12. Xanthelasma Xanthelasma
It affects elderly woman It affects elderly woman
Associated with diabetics and hyper Cholestero Associated with diabetics and hyper Cholestero
laemia laemia
It appears as slightly raised yellow wrinkled It appears as slightly raised yellow wrinkled
plaques near the inner cantus plaques near the inner cantus
Treatment:Treatment:
Surgical excision Surgical excision
Cryotheraphy Cryotheraphy

13. Malignant tumors of the eye lidMalignant tumors of the eye lid
There are three types There are three types
1. Carcinomas1. Carcinomas
2. Sarcomas 2. Sarcomas
3. Malignant melanoma 3. Malignant melanoma

14. Carcinomas Carcinomas
1. Basal cell carcinomas 1. Basal cell carcinomas
2. Squamous cell carcinoma 2. Squamous cell carcinoma
3. Sebaceous cell carcinoma 3. Sebaceous cell carcinoma

15. Sarcomas Sarcomas
1. Kaposi sarcoma – in AIDS patients 1. Kaposi sarcoma – in AIDS patients
2. Reticular tumors 2. Reticular tumors
- Lymphoma - Lymphoma
- Lympho sarcoma - Lympho sarcoma

16. Basal cell carcinoma (rodent ulcer) Basal cell carcinoma (rodent ulcer)
It is the commonest malignant epithelial growth of the It is the commonest malignant epithelial growth of the
eye lid (90%)eye lid (90%)
Risk factors Risk factors
People with fair skin People with fair skin
Chronic exposure to sunlightChronic exposure to sunlight
Rarely occurs before 40yrs of age Rarely occurs before 40yrs of age
Shows predilection for the medial cantus in the lower Shows predilection for the medial cantus in the lower
lid lid
It comments as a small nodule which ulcerates in its It comments as a small nodule which ulcerates in its
central part central part

18. Ulcers Ulcers
Edges are raised an indurate Edges are raised an indurate
Spreads very slowly, extending under the skin in Spreads very slowly, extending under the skin in
all directions and penetrating deeply like a all directions and penetrating deeply like a
Rodent (hence the name) Rodent (hence the name)
The surrounding structures are gradually The surrounding structures are gradually
destroyed an the lids, orbit and the bones are destroyed an the lids, orbit and the bones are
invadedinvaded
The growth is locally malignant, lymphnodes are The growth is locally malignant, lymphnodes are
not affected not affected

19. CLINICAL TYPES:CLINICAL TYPES:
NODULARNODULAR
 ULCERATIVEULCERATIVE
SCLEROSINGSCLEROSING

20. NODULAR TYPENODULAR TYPE
Shiny ,translucent,firm raised indurated nodule Shiny ,translucent,firm raised indurated nodule
with small dilated blood vessels on its surfacewith small dilated blood vessels on its surface
Initially growth is slow but the subsequent Initially growth is slow but the subsequent
growth is faster growth is faster

21. ULCERATIVE TYPEULCERATIVE TYPE
Raised lesion with rolled borders and an Raised lesion with rolled borders and an
ulcerated centreulcerated centre
Dilated blood vessels may course from the Dilated blood vessels may course from the
surfacesurface
Bleeding is common after relatively trivial Bleeding is common after relatively trivial
trauma.trauma.

22. SCLEROSING TYPESCLEROSING TYPE
Originates in the epidermis but soon spreads to Originates in the epidermis but soon spreads to
the dermis the dermis
Occurs as a flat indurated plaque,not associated Occurs as a flat indurated plaque,not associated
with telangiectatic blood vessels of the surfacewith telangiectatic blood vessels of the surface
Occasionally simulate chronic blepharitisOccasionally simulate chronic blepharitis

23. treatmenttreatment
Most small BCC require excision with a 3 mm Most small BCC require excision with a 3 mm
excision of the tissue which look clinically excision of the tissue which look clinically
normalnormal
Standard frozen section involves per operative Standard frozen section involves per operative
examination of tissue at the margin of the examination of tissue at the margin of the
excised tissueexcised tissue

24. SQUAMOUS CELL CARCINOMASQUAMOUS CELL CARCINOMA
It is much less common but potentially It is much less common but potentially
aggressive tumour than BCC with metastasis to aggressive tumour than BCC with metastasis to
the regional lymphnodes the regional lymphnodes
It commonly arises from the lid margin in It commonly arises from the lid margin in
elderly patients elderly patients
Affects lower & upper eye lids equally Affects lower & upper eye lids equally

26. Clinical features Clinical features
It may present in two formsIt may present in two forms
Nodular scc Nodular scc
Ulcerating scc Ulcerating scc
Tumour may arise from with free existing actinic Tumour may arise from with free existing actinic
keratosis or it arises from as a primary lesions keratosis or it arises from as a primary lesions


27. Histology Histology
It is characterized by an irregular downward It is characterized by an irregular downward
proliferation of epidermal cells in to the dermis proliferation of epidermal cells in to the dermis
The malignant cell have a whorled arrangement The malignant cell have a whorled arrangement
forming epithelial pearls forming epithelial pearls

28. Treatment Treatment
Same - on the lines of basal cell carcinaoma Same - on the lines of basal cell carcinaoma

29. Sebaceous cell carcinoma Sebaceous cell carcinoma
It is a rare tumor arising from the Meibomian It is a rare tumor arising from the Meibomian
glands in the tarsal plate glands in the tarsal plate
Affects upper lid commonly females are more Affects upper lid commonly females are more
affected than males affected than males
It metastasis to the regional lymphnodes It metastasis to the regional lymphnodes
Recurrences are more common Recurrences are more common

31. Clinical featuresClinical features
Nodular typeNodular type
It presents initially as a nodule ( which may be mistaken It presents initially as a nodule ( which may be mistaken
for a chalazion) for a chalazion)
Later it grows to form a big growth by destroying the Later it grows to form a big growth by destroying the
Meibomian gland orifice Meibomian gland orifice
Diffuse typeDiffuse type
It grows along the lid margin on forms a diffuse lid It grows along the lid margin on forms a diffuse lid
swelling ( which may be mistaken for chronic swelling ( which may be mistaken for chronic
blepharitis)blepharitis)

32. Treatment Treatment
Surgical excision with reconstriction of the lid Surgical excision with reconstriction of the lid

33. Malignant melanoma Malignant melanoma
It is a rare tumor of the lid ( less than 1%) It is a rare tumor of the lid ( less than 1%)
It may arise from a pre existing melanotic It may arise from a pre existing melanotic
naevus naevus
But usually arises as a primary lesion from the But usually arises as a primary lesion from the
melanocytes present in the skin melanocytes present in the skin

34. Clinical features Clinical features
It often appeasers as a flat are slightly elevated It often appeasers as a flat are slightly elevated
naevus which has varigated pigmentation and naevus which has varigated pigmentation and
irregular borders irregular borders
It may ulcerate and bleed It may ulcerate and bleed
Metastasis:Metastasis: the tumors spread locally as well as the tumors spread locally as well as
to distant sites by lymphatic's and blood stream to distant sites by lymphatic's and blood stream

35. Treatment Treatment
It is a radio resistant tumour It is a radio resistant tumour
Radical surgical excision with reconstruction of Radical surgical excision with reconstruction of
the lid the lid
Exenteration Exenteration