Cyst of the Eyelid

What a cyst of the eyelid is

The eyelid contains several types of glands: around 30 to 40 meibomian glands set vertically inside the firm plate (tarsus) of each lid, which release oil onto the tear film, plus small Zeis oil glands and Moll sweat glands at the eyelash roots. When a gland opening blocks, its secretions build up and the gland swells into a cyst. Cysts can also form from trapped skin cells.

Types of eyelid cyst

A stye (hordeolum) is not a cyst. It is an acute infection of a gland, usually by staph bacteria, and it is painful, red and often has a yellow pus point. A stye can leave behind a chalazion once the infection settles.

Symptoms of a cyst over the eyelid

• A round, smooth lump in the upper or lower lid, usually 2 to 8 mm across, sometimes larger
• Little or no pain, apart from the first few days of a chalazion when the lid can be tender and swollen
• A feeling of heaviness or something in the eye
• Mild redness, especially on the inner surface of the lid when it is turned out
• Watery eye or mild irritation
• Blurred or distorted vision if a large upper lid chalazion presses on the cornea and changes its shape (astigmatism)

Causes and risk factors

• Blepharitis and meibomian gland dysfunction: inflamed lid margins with thick, waxy oil are the main reasons chalazia form and recur.
• Rosacea and seborrheic dermatitis: both thicken gland secretions.
• Previous chalazion or stye.
• Rubbing the eyes, using old eye makeup, and not removing makeup before sleep.
• Diabetes and some acne medicines can play a role.

Most eyelid cysts are not contagious.

How an eyelid cyst is diagnosed

An optometrist, primary care doctor or ophthalmologist diagnoses most eyelid cysts by looking at them, often with a slit lamp microscope, and turning the lid out to see the inner surface. Shining a light through a cyst of Moll shows that it is fluid-filled.

A biopsy is advised when a lump keeps coming back in the same place, when lashes are lost over it, or when it looks unusual in an older adult. This is because sebaceous gland carcinoma, a rare eyelid cancer, can masquerade as a recurrent chalazion or chronic blepharitis.

Treatment

Home care for a chalazion

1. Warm compresses: apply a clean cloth soaked in warm (not hot) water, or a microwavable eye mask, for 5 to 10 minutes, 3 to 4 times a day. Heat softens the hardened oil.
2. Lid massage: after each compress, gently massage the lump toward the lashes with a clean finger for 30 seconds.
3. Lid hygiene: clean the lid margins daily with diluted baby shampoo or lid wipes, especially if you have blepharitis.
4. Do not squeeze or pop the lump. This can spread infection and cause scarring.
5. Pause eye makeup and contact lenses until it settles.

About half of chalazia resolve with this alone over 2 to 8 weeks.

Medical treatment

• Incision and curettage: under local anesthetic, the lid is clamped, turned out, and the cyst is opened from the inside and scraped out. It takes about 15 minutes and leaves no visible scar. You may wear an eye pad for a few hours.
• Steroid injection: a small injection into the lump shrinks it in many cases. It is avoided in darker skin over the lid because it can lighten the skin.
• Antibiotics: only if there is infection. Long-term low-dose oral antibiotics such as doxycycline are sometimes used to treat underlying blepharitis or rosacea in people with recurrent chalazia (not in young children or pregnancy).
• Sweat gland and epidermoid cysts are removed surgically or by opening and draining them. Milia can be lifted out with a sterile needle by a clinician.

Complications

• Infection spreading to the lid (preseptal cellulitis)
• Astigmatism and blurred vision from a large upper lid cyst
• In young children, a large cyst blocking vision can risk a lazy eye (amblyopia), so it is treated sooner
• Recurrence, which is common if blepharitis is not controlled

Preventing eyelid cysts

• Daily warm compresses and lid cleaning if you are prone to chalazia
• Treat blepharitis, rosacea and dry eye
• Replace mascara and eyeliner every 3 months and never share them
• Wash hands before touching your eyes or contact lenses

Frequently asked questions

What are the symptoms of a cyst over the eyelid?

A cyst over the eyelid usually causes a smooth, round lump that is painless or only slightly tender. You may notice a heavy feeling, mild redness inside the lid, watery eye or, with a large upper lid cyst, blurred vision. Severe pain, spreading redness or fever suggest infection rather than a simple cyst.

Is a chalazion the same as an eyelid cyst?

A chalazion is the most common kind of eyelid cyst. It forms when a meibomian oil gland inside the lid becomes blocked. Other eyelid cysts include sweat gland cysts (cysts of Moll), cysts of Zeis, epidermoid cysts and milia.

How long does an eyelid cyst last?

A chalazion often goes away by itself within 2 to 8 weeks with warm compresses and massage. Some last months. Milia and sweat gland cysts tend to persist until they are removed. See a doctor if a cyst lasts more than 6 to 8 weeks or keeps returning.

Can I pop an eyelid cyst?

No. Squeezing or pricking an eyelid cyst can push infection deeper, cause scarring and damage the gland. A doctor can drain it safely through the inside of the eyelid under local anesthetic if it does not resolve with warm compresses.

Can an eyelid cyst be cancer?

Very rarely. Most eyelid cysts are benign. A lump that keeps coming back in the same spot, causes eyelash loss, bleeds or ulcerates, or looks yellow and firm should be biopsied to exclude sebaceous gland carcinoma or basal cell carcinoma.

What is the difference between a stye and an eyelid cyst?

A stye is a painful, red infection of a gland at the lid edge, often with a yellow head of pus, and it usually improves within a week. An eyelid cyst such as a chalazion is a painless blocked gland that develops more slowly and lasts longer. See mass on eyelid to compare other lumps.