For any clinician dealing with ophthalmic diseases, individual lesions of the eyelid and conjunctiva
can be extremely confusing. From a practical perspective such lesions are either benign or
malignant, and can be cystic or solid, melanotic or amelanotic. Certainly the most important
diagnostic question is whether the lesion represents a malignant tumor that requires biopsy and
more definitive treatment. Often, following biopsy, the histopathologic diagnosis is difficult to
interpret since most are histologically based on specific tissue cells of origin. The question
arises, of course, as to the clinical relevance of the diagnosis. For the majority of benign lesions
the treatment will be the same; that is, observation or, if of cosmetic or functional significance,
surgical excision. Some lesions may be amenable to ancillary therapy such as steroid injection,
cryotherapy, laser ablation, or radiotherapy.
Malignant tumors of the eyelid present a special category of concern. Some, like the basal
cell carcinoma, rarely metastasize, but can be locally aggressive; when small they are less of an
immediate threat. Others, such as sebaceous cell carcinoma and malignant melanoma, have a
metastatic potential that requires more immediate and aggressive intervention. A high index of
suspicion and a low threshold for biopsy will lead to a correct diagnosis much of the time.
In the pages that follow we present the current state of our knowledge on a number of
eyelid diseases with which all ophthalmic clinicians should be familiar. Several introductory
chapters discuss eyelid anatomy, examination, evaluation and decision making, and biopsy and
reconstructive techniques. The main body of the atlas is divided into two sections, eyelid
malpositions and eyelid lesions. In Chapter 7: Eyelid Malpositions, we discuss congenital and
acquired dystopias of the eyelids, such as ptosis, ectropion, epicanthus, and lagophthalmos.
In Chapter 8: Eyelid Lesions, we present conditions such as seborrheic keratosis, basal cell
carcinoma, and hemangioma.
The concept of this book grew out of the need for a quick and easy-to-use reference to
specific clinical and histopathologic information on common eyelid malpositions and diseases.
For each condition we give an introduction, clinical presentation, and treatment, with appropriate
illustrations. For eyelid lesions, we also include histopathology and differential diagnosis.
Available information has been condensed into minimal text without cited references. Within
each section, diseases are arranged alphabetically to make it easier to find specific entries. The
reader will find the same information, such as clinical presentation or histopathology, in the
same sequence for every disease. At the end of each disease entry we include selected references
with no attempt at presenting a comprehensive literature review.