Eyelid lesions

Eyelid lesions

1. 🔑 Key concept (high-yield)

• Most eyelid lesions = benign
• ที่พบบ่อยที่สุด:
• Hordeolum (stye) → acute + painful
• Chalazion → chronic + painless
• ต้องแยก benign vs malignant vs urgent condition

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2. 🧠 Approach to evaluation (ใช้ได้จริงในคลินิก)

2.1 History (สำคัญมาก)

• Onset
• <24 ชม → นึกถึง hordeolum
• weeks–months → chalazion / tumor
• Pain
• painful → infection/inflammation
• painless → chalazion / malignancy
• Change over time / recurrence
• suspicious for malignancy
• Red flag symptoms
• ↓vision, diplopia, proptosis → urgent

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2.2 Physical exam

ประเมิน:

• morphology: flat / raised
• color, border, pigmentation
• margin involvement:
• eyelash loss ⚠️
• lid distortion ⚠️
• ulceration / telangiectasia ⚠️

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3. 🚨 Red flags (ต้อง refer ด่วน)

• ↓ visual acuity + red eye → keratitis / zoster
• diplopia / EOM limitation / proptosis → orbital disease
• trauma

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4. 📊 Most common lesions

4.1 Hordeolum (stye)

Key features

• acute (<24 hr)
• painful, erythematous nodule
• Staph infection (Moll/Zeis/Meibomian gland)

Management

• warm compress 5–10 min QID
• ❌ ไม่แนะนำ antibiotic (evidence ไม่ช่วย)
• ให้ ATB เฉพาะ:
• → ถ้าเป็น preseptal cellulitis

Refer

• ไม่ดีขึ้นใน 1–2 สัปดาห์

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4.2 Chalazion

Key features

• painless, firm nodule
• chronic (days–weeks)
• จาก gland obstruction → granulomatous inflammation

Management

• warm compress
• ❌ ไม่แนะนำ antibiotic/steroid
• ถ้า persistent:
• I&D หรือ steroid injection

Red flag

• recurrent same location → rule out sebaceous carcinoma

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5. 👶 Pediatric lesions (ต้องระวัง visual impairment)

• Infantile hemangioma → amblyopia / glaucoma
• Port-wine stain (V1/V2) → glaucoma (Sturge-Weber)
• Dermoid cyst → mass effect
• Congenital nevus → melanoma risk (rare)

👉 ต้อง refer ophthalmology

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6. 👦 Children/adolescents

• Molluscum contagiosum
• central umbilication
• อาจมี chronic conjunctivitis
• Acquired nevus
• symmetric, uniform

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7. 👴 Adult benign lesions (common)

• Squamous papilloma → pedunculated
• Seborrheic keratosis → “stuck-on”
• Epidermal cyst → central punctum
• Xanthelasma → lipid plaque → check lipid
• Actinic keratosis → premalignant

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8. ⚠️ Malignant eyelid lesions (high-yield)

Clues to malignancy

• painless, slow growth
• ulceration / bleeding
• telangiectasia
• eyelash loss
• irregular border / pigmentation
• recurrent lesion

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Important types

8.1 Basal cell carcinoma (most common)

• pearly nodule + telangiectasia
• eyelash loss
• rarely metastasize

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8.2 Squamous cell carcinoma

• crusted ulcer / everted edge
• more aggressive than BCC

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8.3 Sebaceous carcinoma (high-yield exam)

• mimic chalazion
• recurrent lesion
• eyelash loss + lid destruction

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8.4 Melanoma

• ABCDE criteria
• irregular pigmentation

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8.5 Merkel cell carcinoma

• rapidly growing red/purple nodule
• aggressive

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9. 🧾 Indications for referral

Urgent (within 24–48 hr)

• vision change
• orbital signs

Non-urgent

• suspicious malignancy
• recurrent lesion
• cosmetic or functional issue
• persistent chalazion >1–2 months

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10. 💡 Clinical pearls (ใช้จริง)

• Pain = hordeolum, no pain = chalazion
• Recurrent chalazion → biopsy
• Eyelash loss = malignancy until proven otherwise
• Antibiotics rarely needed in stye/chalazion
• เด็ก + lesion รอบตา → think amblyopia risk

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