This document discusses various metabolic changes, degenerative conditions, and tumours that can affect the eyelids. It describes xanthelasma and xanthomas, amyloidosis, actinic keratosis, seborrheic keratitis, keratoacanthoma, basal cell carcinoma, squamous cell carcinoma, malignant melanoma, and sebaceous carcinoma - providing details on their clinical presentation, histological characteristics, affected populations, and other relevant details. Adnexal tumours arising from eccrine, apocrine or holocrine glands are also mentioned.

1. METABOLIC CHANGES AND
DEGENERATION
OPTOM FASLU MUHAMMED

2. XANTHELASMA AND XANTHOMAS
 Elevated ,plaque like or nodular lesions often
multiple and bilateral
 In young, the disease is associated with systemic
hypercholesterolaemia and lipoproteinaemia
 In adults, no underlying cause is noticed

4.  Under microscope there is dermal infiltration of
large foam cells, principally around vascular
channels
 Lesion tends to reoccur in young, if underlying
cause is not rectified

5. AMYLOIDOSIS
 It is an amorphous eosinophilic homogenous substance
deposited in the stroma
 The amyloidosis of lid occurs in secondary form
following extraocular inflammation such as trachoma
 Primary amyloidosis of lid is extremely uncommon

7.  In certain cases there may be associated
palpebral conjunctival amyloidosis

8. TUMOUROUS CONDITIONS

9. ACTINIC KERATOSIS
• The lesions are secondary to exposure to sunlight
• Elderly individuals are primarily affected
• Face and eyelids are common sites of the lesion
• Clinically the Actinic Keratosis is a hyperplastic
proliferative lesion
• Over 50% of cases evolve into invasive squamous cell
carcinoma in a period of 3-5 years

12. SEBORRHOEIC KERATITIS
 It is a nodular /plaque like condition with
morphological appearance of “button stuck” on the
skin
 The condition commonly affects elderly male with skin
of eyelid as common site histologically , Seborrhoeic
Keratitis s characterised by marked acanthosis,
hyperkeratosis and prominence of basal cell layer

14.  The diagnostic feature that helps to distinguish
seborrhoeic keratitis from squamous cell
carcinoma or basal cell carcinoma is the location
of the lesion entirely external to a line drawn
from the adjacent normal epidermis

15. KERATOCANTHOMA
 It is one of the commonly mistaken benign
lesions for the squamous cell carcinoma
 Multiple proliferative nodular lesions occur over
face generally in the youth

17. TUMOURS

18. BASAL CELL CARCINOMA
 BCC is the commonest eyelid tumour over 40
years of age
 In the west BCC accounts for more than 80% of
malignant eyelid tumours.
 Clinically as the name rodent ulcer
synonymously used for BCC,the ulcerative
nodular epithelial neoplasm has everted edges
with burrowing of invading margins

19. CLASSIFICATION
 BCC is histologically classified into 5 types
 Multicentric
 Keratotic
 Adenoid cystic
 Morphea
 Adenoid

20.  Basically the neoplasm shows proliferating basal cells
in bulbous or lobular fashion with characteristic
palisading of basal cells in the periphery of each
lobule.
 The basal lamina is prominent, sometimes hyaline
 The basaloid cells in some tumours exhibit maturation
to squamous and elaborate exuberant keratin when
the lesion is called Keratotic BCC.

21.  In Morphea type, the hyalinization or desmoplastic
reaction is marked compared to neoplastic cellular
component .
 In adenoid or adenoid cystic carcinoma ,as the term
denotes, the proliferating basal cells infiltrate dermis
in delicate trabecular fashion, encircling small areas of
loose tissue, giving adenoid or adenoid cystic
appearance

23. SQUAMOUS CELL CARCINOMA
 Commonest eyelid tumour in the Indian
subcontinent.
 Elderly males are frequently affected with upper
eyelid being commoner than lower
 Exophytic,proliferative ,nodular or ulcerative
growth involving external aspect is the
commonest clinical presentation

24.  Histologically, the squamous cell carcinomas are
characterized by proliferative polyhedral
squamous cells with varying degrees of
pleomorphism ,hyperchromasia invading the
stroma in trabecular or lobular fashion.

25. MALIGNANT MELANOMA
 It is rare in India
 Malignant Melanoma , when it is young, one
should suspect associated Xeroderma
Pigmentosum , a hereditary autosomal recessive
disorder.
 Clinically the pigmented lesion may occasionally
be poorly pigmented, affecting the lid margin

26.  It is a plaque or, nodule or rarely ulcerated lesion.

27. ADNEXAL TUMOURS
 It may arise from eccrine,apocrine or holocrine
 The structural pattern of the adnexal tumours of
the eyelids do not differ from those that occur
elsewhere in the body
 Face is the commonest site for sebaceous gland
tumours compared to other sites, so is the eyelid

28. SEBACEOUS CARCINOMA
 It is the most frequent eyelid tumour
 It ranks equal to the squamous cell carcinoma in its
incidence in India it may arise from Zeiss or
meibomian glands
 Upper eyelid is the commonest site and clinically
,early lesions mimic chalazion

30.  Elderly males are more affected than females
 Sebaceous gland is a holocrine gland and the
secretions are the result of death of central cells
 They have no distinct ducts in general and their
secretions open into hair follicles.

31.  However the meibomian glands which are
embedded in the tarsal plate open at the lid
margins through a separate duct lined by the
squamous epithelium
 Orifices of the ducts represent junction of skin
and eyelid with palpebral conjunctiva

33.  The sebaceous glands,exhibit peripheral basaloid
cells which gradually mature towards centre
acquiring foamy(lipid) character
 It may be nodular ulcerative lesion or
proliferative lesion.
 External location is often due to its origin from
Zeiss gland
 Marginal or internal sebaceous carcinoma are the
true meibomian gland gland carcinoma

34.  It is characterised by irregular lobules of basaloid
cells infiltrating the dermis
 From the periphery the cells show maturation to
foamy cells in the centre
 The lobules or islands of the tumour are
composed of oval to round cells, with deeply
stained nuclei and clumped chromatin