The eyelids may be affected by benign as well as malignant lesions, most of which are common elsewhere on the body. When lesions occur on the eyelid, however, they often are different in character, appearance, and behavior because of the unique characteristics of eyelid skin.

Many cutaneous and systemic disorders are associated with eyelid lesions. In many instances, the eyelid findings are quite specific for a particular disorder; in other cases, they may be rather nonspecific.

If an eyelid lesion is located unilaterally, it probably indicates a benign or malignant neoplasm, inflammation, or infection. If it is bilateral, it usually is associated with disseminated systemic conditions such as collagen vascular diseases, metabolic disorders, vesiculobullous diseases, or hypersensitivity reactions.

An eyelid lesion usually is classified according to the anatomic structure from which it arises. Structures include the layers of the skin, blood vessels, sweat and sebaceous glands, and various tissues within these layers.

Eyelid inflammation may present as a localized or diffuse erythematous area. It may be associated with ulceration, induration, eczematous changes, necrosis, edema, or loss of eyelashes. The challenge lies in differentiating an inflammation from a malignant lesion, as the line of management is completely different.

If the skin is contracted, the eyelid margins may be malpositioned, manifesting as an ectropion or canthal angle dystopia. Inflammatory and infective lesions usually are painful, whereas a suspected malignancy usually is painless; at times, both may be associated with lymphadenopathy.

If an eyelid infection is not responding to treatment or is atypical or recurrent, a biopsy, smear, or culture is helpful in excluding the presence of occult malignancy or an unusual infectious organism. As a general rule, a biopsy should be performed in any case of recurrent stye in the same location as well as in patients with a nonhealing ulcer of the lid margin, a lid nodule increasing in size, local loss of eyelashes over the lesion, telangiectatic vessels surrounding and passing over the lesion, and a diffuse area of induration.