Our eye lids serve many functions that are required to keep our eyes healthy and functioning well. Among these important acts are to clean the eyes with blinking, keeping them moist, removing debris, protection and even avoidance. This last function is accomplished when the eye lashes come in contact with foreign matter and warn us of approaching danger.

Unfortunately, the lids are also a prime location for pathology and lid growths due to their constant exposure to UV light and pollution. Most lumps and bumps on the lids are benign and while they may not look pretty they are not dangerous. There are however, some lid lesions that are very serious. Topping the list in the bad category is Squamous cell carcinoma. It grows slowly and painlessly and may take many months before it is even noticed. It often starts as a wart like growth with a keratotic outer layer, but evolves into an ulcer with a fissure centrally. The base of the tumor becomes indurated, red with an ample blood supply and hard edges. It must be excised early on in order to prevent extensive damage to the surrounding tissue. As is grows it may spread to the connective tissue and even the underlying bone. At this point the pain is constant and severe. The greatest danger with Squamous cell carcinoma is that it metastasizes to other body areas. This is accomplished by use of the lymphatic system to the preauricular and sub maxillary lymph nodes. Once this occurs the prognosis for recovery is much less positive. Early treatment will prevent secondary complications and complete elimination of the cancer is possible.

Basal cell carcinoma by contrast is a localized lesion and does not spread throughout the body. It does its' damage locally. It also is a slow growing tumor and may appear like a little bump at first then changing to a volcano like growth with rounded edges. It frequently bleeds and continues to grow under the skin even as the outer appearance may remain the same. The damage can be quite extensive if not excised early on. Often facial reconstruction must be performed in order to clean out the entire tumor.

As is often the case in medicine, there are other lesions that look serious, but are quite safe and benign. Keratoacanthomas is a prime example. It looks a lot like an early Squamous or Basal cell carcinoma, but is simply a "bump" that is comprised of keratinized tissue and is therefore also confused with an inverted follicular keratosis. Both are benign , but should always be removed and tested to make sure they are these 2 conditions. Only the trained and experienced eye can make that differential diagnosis.

Sarcomas and Malignant Melanomas are usually easier to diagnosis since they have more unique appearances. Obviously both require immediate treatment and follow up care. Other simple lid lesions are Chalazions and Hordeolums commonly known as Styx. They are treated with hot compresses and should resolve in a week or two.

The bottom line is that if there are any bumps or changes on the eye lids all patients should have them evaluated by their eye doctor. It most often is nothing serious, but early treatment for all lid lesions results in better long term eye health and appearance.