Infants with noninfected mucoceles should be treated with warm compresses and topical antibiotics. If the lesion does not resolve, or if the mucocele becomes infected, referral to a pediatric ophthalmologist is indicated.

Infants with hemangiomas involving the eyelids or periocular structures should be referred to a pediatric ophthalmologist due to the risk of amblyopia.

Styes and chalazia should be treated initially with warm compresses. Topical antibiotics may also be used. Most resolve with conservative treatment in 1 to 2 months. If they do not, referral for incision and drainage may be indicated.

What Shouldn’t Be Missed

Infantile mucoceles are almost always associated with nasolacrimal duct cysts. If these are large, they may cause respiratory difficulties. These patients require prompt nasal endoscopy and removal of the cysts.

• 1. Hemangioma. Hemangiomas are vascular lesions that develop within the first few weeks of life. They usually go through a fairly rapid growth phase over the next few months, then slowly involute. The lesions themselves are benign, but periocular hemangiomas can cause amblyopia, either due to obstruction of vision or by inducing astigmatism (Figure 13–1).
  
• 2. Orbital dermoids. Orbital dermoids are benign lesions that arise from entrapment of ectodermal tissue between the growth plates during the embryological development of the skull. They are most commonly located along the superolateral orbital rim (Figure 13–2). They may rupture, which can incite a marked inflammatory response.
  
• 3. Mucocele (dacryocele, dacryocystocele, amniotocele). These lesions result from dilation of the lacrimal sac in newborns with lacrimal obstruction. They present as blue-tinged masses overlying the lacrimal sac between the eye and the nose (Figure 13–3). They may become infected and produce an abscess within the lacrimal sac, in which case prompt treatment is warranted.
  
• 4. Chalazion/stye/hordeolum. Styes result from blockage of the oil glands of the eyelids. The initial inflammatory phase may be associated with diffuse erythema and swelling of the eyelid, which can appear similar to preseptal cellulitis (Figure 13–4). If the lesions do not resolve, they may transform into firm nodules (chalazia) (Figure 13–5). Some patients are prone to recurrent styes.
  
• 5. Other. A wide variety of lesions may present as bumps around the eyes. The most common are discussed above. Examples of other eyelid lesions include conjunctival dermolipomas (Figure 13–6), conjunctival nevi (Figure 13–7), pilomatrixoma (Figure 13–8), and papillomas (Figure 13–9). These lesions are discussed in more detail in Chapters 25, 26, and 27.