Cysts in the Eyelid: Types and Characteristics
A cyst in the eyelid is most commonly called a chalazion, which is a localized cyst of chronic lipogranulomatous inflammation arising from obstruction of sebaceous glands in the eyelid tarsal plate. 1
Common Types of Eyelid Cysts
- Chalazion: A localized cyst formed due to blockage of the meibomian gland (deep chalazion) or Zeis gland (superficial chalazion) 1
- Hordeolum (stye): An acute purulent localized swelling of the eyelid associated with an eyelash follicle, Zeis gland, or Moll gland obstruction and infection 1
- Epidermoid inclusion cyst: A keratin-filled cyst that can develop within the tarsus, often initially resembling a chalazion 2
- Cysts of Moll: Benign cysts arising from the apocrine sweat glands of Moll 3
- Cysts of Zeis: Benign cysts arising from the sebaceous glands of Zeis 3
- Trichilemmal cyst: A cyst lined by stratified squamous epithelium with a compact layer of eosinophilic keratin without granular cell layer 4
- Lacrimal gland ductal cyst: A rare cyst that develops in the lacrimal gland duct, typically after chronic inflammation, infection, or trauma 5
Clinical Features of Chalazia
- Present as a firm, painless nodule within the eyelid 1
- Can develop on either the upper or lower eyelid 6
- May cause localized swelling, redness, and mild discomfort 1
- Usually resolve spontaneously but can persist for months 6
- May be associated with blepharitis or meibomian gland dysfunction 6
Distinguishing Features
- Chalazion: Painless, firm nodule within the eyelid; often chronic 1
- Hordeolum: Painful, erythematous swelling at the eyelid margin; typically acute 1
- Epidermoid inclusion cyst: Lacks inflammation, doesn't fluctuate in size, shows gradual continued slow growth 2
- Sebaceous carcinoma: Can mimic chalazion but shows features like gradual enlargement, central ulceration, irregular borders, eyelid margin destruction, loss of lashes, or telangiectasia 3
Warning Signs That Require Further Evaluation
- Recurrence in the same location (raises suspicion for sebaceous carcinoma, especially in elderly patients) 7
- Marked asymmetry or resistance to therapy 7
- Atypical features such as eyelid margin distortion, lash loss, or ulceration 7
- History of multiple chalazion excisions at the same site 6
Management Considerations
- Warm compresses and gentle massage are first-line treatments for chalazia 1
- Recurrent chalazia in the same location should prompt consideration of biopsy to rule out sebaceous carcinoma 7
- Incision and curettage is effective for typical chalazia but not for intratarsal epidermal inclusion cysts, which require complete excision including the tarsus at the cyst's base 2
- Children with chalazia may have underlying chronic blepharokeratoconjunctivitis that requires evaluation by an ophthalmologist 7
Complications
- Secondary infection leading to abscess formation 5
- Cosmetic deformity of the eyelid 6
- Visual disturbance if the chalazion is large enough to induce astigmatism or block vision 1
- Rarely, sebaceous carcinoma may be misdiagnosed as a chalazion, leading to delayed treatment 6
Understanding the specific type of eyelid cyst is crucial for appropriate management and to rule out more serious conditions that may mimic benign cysts.