Lumps and Bumps of the Eyelids


Growths on the eyelids may be totally benign or vision and life threatening.  Accurate diagnosis and treatment is essential.  As a doctor in training  we joked that every growth on the lower eyelid was a basal cell carcinoma (skin cancer) until proven otherwise and every growth on the upper eyelid was a chalazion (acute or chronic sty) until proven otherwise.  This is not a bad rule but is certainly not inclusive.

Why Do The Lower Eyelids Get Cancers More Often?

The lower eyelids get much more direct sun exposure than the upper eyelids which are protected from direct sun exposure by your overhanging eyebrows and by usually being open in direct sunlight.  Subsequently, tumors caused by sun exposure are much more common on the lower eyelids and the region between the eye and the nose (medial canthus).

What Do You Do With Bumps on The Eyelids ?

Eyelid tumors, especially basal cell carcinomas, are very treatable if diagnosed early and excised completely.   A surprisingly large amount of lower eyelid may be removed and the eyelid repaired with minimal cosmetic and functional defects.  If the tumor is allowed to grow and involve the entire eyelid or adjacent structures the visual and functional results are not as good or as predictable.  Bottom line- have those bumps on the lower eyelid evaluated and treated.  If basal cell skin cancers are diagnosed and completely excised they are cured.  Its worth the effort to get them evaluated. The most dangerous four words in medicine are “it will go away”.

Squamous Cell Skin Cancers

Squamous cell skin cancers are also sun induced and more prevalent on the lower eyelids.  They are also very treatable; but these tumors have a tendency to spread along the nerves and invade the brain.  These are potentially much more dangerous and need to be excised more aggressively and also completely.  These tumors can kill you very dead and very unpleasantly.

Colored Eyelid Tumors

Pigmented tumors anywhere on the eyelids or for that matter anywhere on your body are worthy of respect.  Pigmented growths are malignant melanomas until proven otherwise and any pigmented lesion needs to be either excised and examined by a skilled dermato-pathologist or serially observed by a physician experienced with melanomas.  These are usually dermatologists and it is my opinion that they should be involved in the care of most any patient with a suspected melanoma.  These tumors are well known to spread through out the body (metastasis) and can also kill you very dead.

What Can Be Done To Prevent Eyelid Cancers

All three of these eyelid tumors we discussed can occur on any skin surface that is exposed to sunlight and are directly related to sun exposure.  The take home point is to use your sun block (spf 15 or greater), wear a visor and sunglasses.  Your eyes and your eyelids will be much happier and healthier for your efforts.

Eyelid Sty / Chalazion

What about the upper eyelids?  As I mentioned they are partially protected from sun exposure by the fact that they are open and that the overhanging brow protects them from direct sun exposure.  The most common mass on the upper eyelid is the chalazion, often called a sty.  This is benign and is caused by blockage of a tiny gland in the upper eyelid (there are over a hundred per eyelid).   The blocked gland becomes infected.  If the infection is treated it usually resolves with no lasting damage to the eyelid.  Untreated, the body tries to form a barrier around the infection to contain it.  This forms a nodule of inflammatory tissue that may require excision and drainage to resolve and may cause some eyelid dysfunction.  This is benign but may be a bit of a nuisance.

Recurrent Chalazions

Problems arise when presumed chalazions recur and are not biopsied.  This is known as the masquerade syndrome.  What was initially thought to be a chalazion was really a cancer of the sebaceous glands (sebaceous cell carcinoma).   This is a rather rare tumor and not seen by many eye MDs, hence it is often misdiagnosed as either a recurrent chalazion or if the biopsy and pathology examination was inadequate a basal cell carcinoma.  Remember that basal cell carcinomas are very uncommon on the sun protected upper eyelids and that diagnosis should always be suspect and a better biopsy and pathologic study done to diagnoses sebaceous cell carcinoma which is potentially lethal disease and needs to be treated more aggressively.

It is important to have any new or old lesions evaluated by a doctor who is trained in eyelid tumors. At Sarasota Retina Institute Drs. Spoor, Abrams, and Levy are specialist in diagnosing and treating tumors of the eyelids. If you have a lesion you need checked call 941-921-5335 for an appointment.


Tom Spoor, MD
Oculoplastics and Neuro-ophthalmology
Sarasota, Florida

Tom Spoor,MD
Oculoplastics and Neuro-ophthalmology
Warren, Michigan

Jody Abrams, MD, FACS
Sarasota Retina Institute
Sarasota, Florida 34239