Lumps and bumps in their various forms occur all over the human body and the eye is no exception. Most people will notice some sort of bump on the eyelid or the eyeball itself at some point – the question is, is this little lump something to be worried about?
Pingueculae and pterygia
Potentially one of the most common bumps you’ll find on the eye, a pinguecula is a whitish-yellowish growth on the conjunctiva, which is the clear membrane covering the white of the eye (the sclera). Pterygium (also known as surfer’s eye) is a common overgrowth of conjunctiva but can extend to cover part of the cornea, the transparent bubble over the colored iris, while pingueculae remain just on whites. Both are entirely benign though can sometimes mimic the appearance of a cancerous lesion such as squamous cell carcinoma, making it important to see your eye doctor if you notice any suspect bumps on your eye.
Most people are not bothered by the presence of pterygia or pingueculae once they’ve been assured it’s not a cancer. Occasionally these bumps can become inflamed during dry or dusty environmental conditions or sometimes just at random, which causes some irritation and redness of the eye. This typically self-resolves in a short time though applying lubricating eyedrops or a cold compress can help with comfort in the meantime. If the redness needs to go quick-smart because you have a photoshoot tomorrow then instilling steroid eyedrops can effectively quash the inflammation. If you have a bit more time before the photoshoot, some pterygia are large enough to warrant surgical removal, especially if it has progressed so far over the cornea as to affect vision or frequently becomes inflamed and irritated. Rates of the pterygium recurring after surgery can be as high as 89% but Dr. Michel’s recurrence rate is less than 1%.
UV Exposure and Dry Eye Disease
UV exposure and dry eye disease are thought to contribute to the development of both pterygia and pingueculae so the use of sunglasses for sun protection and artificial tears to address dry eye are easy ways to reduce the likelihood of developing these little bumps or to stop them from getting bigger. The incidence of pterygia and pingueculae also increases with increasing age though there’s probably not much you can do about that.
Styes and chalazia
You’ve probably experienced a stye, also known as a hordeolum, at some point. A sore bump on the eyelid, either around the eyelash line or farther up the eyelid, these tender red lumps are typically caused by a bacterial infection of either the eyelash follicle and its oil glands (an external stye) or of the sebum-producing Meibomian glands inside the eyelid (an internal stye). Many patients who find themselves prone to recurrent styes will also have some degree of an eyelid condition known as chronic blepharitis, which refers to an accumulation of excessive bacteria, skin oils, and other irritants around the eyelids, leading to inflammation. While in most cases a stye will go away by itself in a few days, applying a warm compress can help it to resolve quicker and it also makes sense to address any blepharitis that may be causing the stye to flare up. It’s important not to try and pop the stye like you might a pimple as this can spread the bacterial infection throughout the surrounding eyelid tissues and if you thought a little stye on the eyelid was unattractive, wait til you get preseptal cellulitis.
On occasion, an internal stye may evolve into a chalazion, which is simply a blockage of the eyelid’s Meibomian glands. On the upside, chalazia are painless even if you poke it; on the downside, chalazia can hang around for several months at a time. Warm compresses and gentle massage may help to resolve it more quickly but bothersome cases – such as those causing visual distortion by pressing on the eyeball or if you have another photoshoot coming up – may need to be managed by an eye doctor, either with surgical draining or steroid injection.
Milia and xanthelasma
These are another two benign bumpy lesions around the eyelid. Milia are typically found on the skin of newborn babies (not just on the eyelids) but can occur at any age. Keratin becomes trapped beneath the surface of the skin and forms a white or yellow cyst-like bump, just a millimeter or two in diameter. They’re painless and harmless and most will disappear in a few months without any intervention. Keep the area clean with a non-irritating cleansing soap and resist the urge to pop them as this can spark an infection.
Xanthelasma presents as a yellowish irregularly-shaped raised area around the eyelids, usually on the side closest to the nose. These plaques are caused by accumulation of lipid deposits but only about 50% of cases are associated with high blood cholesterol (hyperlipidemia). In these situations, the more pressing issue is to sort out the hyperlipidemia (think strokes and heart attacks) but the xanthelasma itself is considered more of a cosmetic problem. If that photoshoot is looming ever closer, an eye doctor can manage xanthelasma with certain medications, laser therapy, or surgery. However, be aware that xanthelasma often returns even after successful treatment and many of these treatment options run the risk of scarring or skin discoloration. For such a benign, painless lesion, the risks of treatment may not be worth it.
Carcinoma of the eye and eyelid
Unfortunately, the eyeball and eyelid are not immune to cancerous lesions such as basal and squamous cell carcinomas. Often these lesions can copy the appearance of other benign lumps and bumps, delaying their diagnosis and management. Metastasis tends to be rare though fatalities arising from carcinomas of the eye are not unheard of so it is important to seek an eye doctor’s opinion if you notice an unusual bump around your eye. If there is distortion of the eyelash line or loss of eyelashes from a bump at the eyelid margin, an ulcerated or flaky lesion on the eyelid, or a growing bump on the whites of the eye, particularly if you can notice prominent blood vessels leading to it (feeder vessels), then have it checked out by an eye doctor promptly.
Sun protection for the eyes can do wonders, not only for the crows-feet developing from squinting against sun glare, but also for reducing the risk of UV-related lumps and bumps such as pinguecula and basal cell carcinomas. Though the majority of lesions around the eyes are likely to be harmless, play it safe if you notice anything new and unusual and leave lots of time to have it checked by an eye doctor before your next photoshoot.
What is a pinguecula and a pterygium (surfer’s eye)? https://www.aao.org/eye-health/diseases/pinguecula-pterygium
How to minimize pterygium recurrence rates: clinical perspectives. https://www.dovepress.com/how-to-minimize-pterygium-recurrence-rates-clinical-perspectives-peer-reviewed-fulltext-article-OPTH
Chalazion (meibomian cyst). https://www.college-optometrists.org/guidance/clinical-management-guidelines/chalazion-meibomian-cyst-.html
Eye styes: causes, symptoms, treatments. https://www.allaboutvision.com/conditions/styes.htm
How can I get rid of milia? https://www.medicalnewstoday.com/articles/320953.php
Xanthelasma: an update on treatment modalities. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5921443/
What is xanthelasma? https://www.webmd.com/eye-health/xanthelasma