Eyelid lesions should be treated in a timely manner in order to prevent progression of the lesion or further damage due to malignancy. Your eye surgeon will discuss the best treatment options with you after they have diagnosed the type of eyelid lesion and any associated complications.
Treatment for Benign Lesions such as Chalazia
In the early phase of the inflammation caused by chalazia, you may follow conservative treatment with eyelid scrubs and warm compresses. Your eye doctor may prescribe anti-inflammatory ocular ointments or drops or a topical antibiotic, but these may only offer minimal benefit.
If the chalazia infection is acute and localized cellulitis or abscess has occurred, you may benefit from oral antibiotics aimed toward Gram-positive bacteria such as Staphylococcus aureus. If a large painful abscess has developed, early surgical drainage of the abscess can be helpful.
Systemic doxycycline medical can provide long-term suppression of meibomian gland inflammation and may speed up the resolution of chalazia. Some patients may need a tetracycline maintenance dose, which may be better tolerated compared to doxycycline in some patients. You may have to continue this suppressive treatment for at least two months.
The larger chalazia often require surgical treatment. Simple incision and curettage of the chalazion may help in resolving the condition permanently. If inflammation is more on the posterior eyelid margin, an incision through tarsus and conjunctiva is appropriate for drainage. Localized injections of corticosteroids can be beneficial for treating small chalazia. However, it may cause depigmentation of the overlying skin and may be less effective compared to surgery.
Treatment for Premalignant Epidermal Lesions
About 25 percent of actinic keratoses will resolve one their own over several months, but new lesions will continue to develop. For lesions occurring in the periocular region, your surgeon may perform a biopsy to establish a definitive diagnosis and any early signs of malignancy. The eye surgeon may treat these lesions with full excision or cryoablation. Alternative therapies may sometimes include 5-fluorouracil or imiquimod dermatologic cream.
Bowen’s disease represents squamous cell carcinoma (SCC) in situ involving the skin. Your surgeon may perform a full surgical excision to prevent the risk of malignancy.
Keratoacanthoma is now considered by many experts as a low-grade SCC. Gradual spontaneous involution may occur over a few months. Total surgical excision is the treatment of choice in most of these cases.
Lentigo maligna or precancerous melanosis is an irregular pigmented eyelid lesion that usually involves the malar regions. The gradual, progressive enlargement of the lesion represents an uncontrolled growth phase of melanocytes that may last for many years, could eventually progress to malignant nodules. Complete wide excision with permanent sections for monitoring the surgical margins may be necessary to minimize the risk of invasive melanoma.