Eyelid lumps and cysts
Most eyelid lumps are harmless. A small number are not, and the difference matters. These are the questions people ask.
What is this lump on my eyelid?
Chalazion. The commonest by far. A meibomian gland blocks, the trapped oil leaks into the surrounding lid tissue, and the body walls it off with a firm nodule. It sits within the lid rather than at the margin, is usually painless once the initial inflammation settles, and can persist for months.
Stye (external hordeolum). An acute infection of a lash follicle at the lid margin. Red, tender, points outwards near the lashes, and usually discharges and settles within a week or two.
Internal hordeolum. An acutely infected meibomian gland, deeper in the lid. More painful and more diffusely swollen than a chalazion, and it can settle into one afterwards.
Cyst of Moll. A small clear fluid-filled blister on the lid margin, from a sweat gland. Harmless, easily removed if it is a nuisance.
Cyst of Zeis. Similar in position but yellowish and greasy rather than clear, from a sebaceous gland.
Epidermoid or sebaceous cyst. A firm, smooth, skin-coloured lump in the lid skin, often with a small central dot. Benign. Removed if bothersome or repeatedly inflamed.
Xanthelasma. Soft yellowish plaques near the inner corner of the lids, from lipid deposits. Harmless in themselves, but worth having your cholesterol checked.
Papilloma and skin tags. Common, benign, removed for comfort or appearance.
Will it go away on its own?
Often, yes — particularly styes, which usually settle within a week or two.
Chalazia are slower. A good proportion resolve with heat and massage done properly and for long enough, which usually means weeks rather than days. See the blepharitis page for how to do it properly, because the technique matters more than people expect.
Can I squeeze it?
No. Please don't.
Squeezing a stye or a chalazion pushes infection deeper into the lid and can turn a self-limiting problem into a spreading one. Warm compresses, not pressure.
What if the heat doesn't work?
A chalazion that has been there several weeks and is not settling can be treated with incision and curettage — a short procedure in the clinic under local anaesthetic, done through the inside of the lid so there is no visible scar.
A steroid injection into the lesion is an alternative in some cases.
Why do I keep getting them?
Because of the blepharitis underneath.
This is the direct link between the two problems: a chalazion is a complication of the same blocked oil glands that cause gritty, burning eyes. Treating the blepharitis is how you stop getting them.
If you have had two or three chalazia, treating the individual lump is only half the job.
Do I need antibiotics?
Usually not. Most styes settle without them, and a chalazion is not an infection at all — it is a walled-off reaction to leaked oil, so antibiotics do nothing for it.
When should I be worried?
Most lid lumps are benign, but the following features need proper assessment. Come in if a lump:
- is growing steadily rather than settling
- is ulcerated, crusting or bleeding
- has destroyed the normal lash line, or caused lashes to fall out in one specific spot
- has abnormal blood vessels running over it
- is pearly, with a rolled edge
- distorts the lid margin
- is a chalazion that keeps coming back in exactly the same place
That last one deserves emphasis. A recurrent chalazion at the same site in an older patient is the classic presentation of sebaceous gland carcinoma. It is rare, but it is serious, and it can masquerade as a benign lump for a long time. Any persistent or recurrent lid lesion with atypical features should be biopsied rather than assumed.
Basal cell carcinoma is by far the commonest eyelid cancer. It favours the lower lid and the inner corner, and it is highly treatable when caught early.
Nobody will think you are wasting anyone's time by having a lid lump looked at.
Next steps
Patients — contact the clinic to arrange an appointment.
GPs and optometrists — refer directly to Limerick or Ennis, including by Healthmail.