The eyelids are the first structure examined under the slit lamp microscope and are often quickly evaluated. Yet a ccurate assessments of common eyelid conditions and appropriate medical management can improve patients' quality of life. The October issue of Review of Optometry gives readers a rundown on best practices regarding eyelid health. Check out the other featured articles here:. The profession is evolving, and more optometric physicians are becoming confident with minor surgical procedures, including the management of eyelid lumps and bumps.
Beginning with Oklahoma in , about 17 states now privilege optometrists to perform minor surgical procedures. However, we should all have the foundational knowledge to appropriately diagnose and manage, whether that means in-house removal or referral.
A good grasp of eyelid and adnexa anatomy is essential in the management of eyelid lesions. Though eyelid skin is the thinnest anywhere on the human body, it contains an array of structures including epithelium, muscle, fat, tarsus, conjunctiva as well as dermal adnexal structures such as eyelash hair follicles, sweat and sebaceous glands, nerve fibers and associated blood and lymphatic vessels.
Most eyelid lesions encountered in clinical practice are benign. However, there is some variability in their clinical presentations. This can lead to overlap of characteristics even between benign and malignant lesions. In our office, we send a sample of all excised masses to the pathology department for confirmation. Histologic terms such as hyperkeratosis , acanthosis and dyskeratosis are useful to pathologists.
However, we find it more clinically advantageous to describe neoplasms on the basis of physical characteristics such as size, attachment sessile vs. In a world where our profession is driven to see more and more patients with ever more complex health conditions, it can be tempting to cut corners. It is, however, incumbent upon the clinician to take a few moments to grossly observe the patient prior to moving on with the eye exam. Much can be gleaned by looking at basic symmetry or the condition of exposed skin of other parts of the body during a face-to-face history.
