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About 10 years ago, this 63-year-old man noticed a lesion on his eyelid. It didn’t bother him, so he ignored it—until recently, when it reached a size sufficient to interfere with his vision. This development, and subsequent commentary from friends concerned by its proximity to his eye and fears of cancer, disturbed him enough to seek evaluation.
He first consulted an ophthalmologist, who provided a diagnosis that the patient promptly forgot. However, he was also advised to see a dermatologist or plastic surgeon for further evaluation, since the lesion does not affect the eye itself. The patient wants the lesion removed but seeks a dermatology referral first.
He denies pain, discomfort, or trauma to the affected area.
EXAMINATION
A translucent, round, 7-mm cystic lesion is located on the left lateral lower eyelid just below the margin, resembling a bleb. No redness is seen in the area. Palpation confirms the soft, cystic nature of the lesion.
Examination of the other eye and the rest of the patient’s facial skin reveals no abnormalities.
What is the diagnosis?
DISCUSSION
This is a typical presentation of an apocrine hidrocystoma (AH), a benign lesion of uncertain etiology. The eyelid is rich in apocrine, eccrine, and sebaceous glands, all of which can transform into cysts via traumatic plugging.
AH is also known as cystadenoma, Moll gland cyst, or sudoriferous cyst. It is an entity distinct from chalazions (a granulomatous reaction to sebaceous glands in the eyelid) and lacrimal duct cysts. The differential includes basal cell carcinoma, intradermal nevus, and eccrine cyst.
In my experience, merely incising and draining the cyst is useless in the long run; while this does reduce swelling, it also invites recurrence. Therefore, removal by saucerization and cauterization of the base is the best treatment option.
TAKE-HOME LEARNING POINTS
- Apocrine hidrocystomas (AHs) are benign cysts derived from plugged apocrine sweat glands, which are found in numerous areas around the body, including the eyes.
- AHs are also known as cystadenomas, Moll gland cysts, or sudoriferous cysts.
- Though AHs are often found near the eye, they are not technically an eye problem—but they do have potential to obstruct the visual field.
- Removal is usually by saucerization, with cautery of the base for hemostasis and prevention of recurrence.
About 10 years ago, this 63-year-old man noticed a lesion on his eyelid. It didn’t bother him, so he ignored it—until recently, when it reached a size sufficient to interfere with his vision. This development, and subsequent commentary from friends concerned by its proximity to his eye and fears of cancer, disturbed him enough to seek evaluation.
He first consulted an ophthalmologist, who provided a diagnosis that the patient promptly forgot. However, he was also advised to see a dermatologist or plastic surgeon for further evaluation, since the lesion does not affect the eye itself. The patient wants the lesion removed but seeks a dermatology referral first.
He denies pain, discomfort, or trauma to the affected area.
EXAMINATION
A translucent, round, 7-mm cystic lesion is located on the left lateral lower eyelid just below the margin, resembling a bleb. No redness is seen in the area. Palpation confirms the soft, cystic nature of the lesion.
Examination of the other eye and the rest of the patient’s facial skin reveals no abnormalities.
What is the diagnosis?
DISCUSSION
This is a typical presentation of an apocrine hidrocystoma (AH), a benign lesion of uncertain etiology. The eyelid is rich in apocrine, eccrine, and sebaceous glands, all of which can transform into cysts via traumatic plugging.
AH is also known as cystadenoma, Moll gland cyst, or sudoriferous cyst. It is an entity distinct from chalazions (a granulomatous reaction to sebaceous glands in the eyelid) and lacrimal duct cysts. The differential includes basal cell carcinoma, intradermal nevus, and eccrine cyst.
In my experience, merely incising and draining the cyst is useless in the long run; while this does reduce swelling, it also invites recurrence. Therefore, removal by saucerization and cauterization of the base is the best treatment option.
TAKE-HOME LEARNING POINTS
- Apocrine hidrocystomas (AHs) are benign cysts derived from plugged apocrine sweat glands, which are found in numerous areas around the body, including the eyes.
- AHs are also known as cystadenomas, Moll gland cysts, or sudoriferous cysts.
- Though AHs are often found near the eye, they are not technically an eye problem—but they do have potential to obstruct the visual field.
- Removal is usually by saucerization, with cautery of the base for hemostasis and prevention of recurrence.
About 10 years ago, this 63-year-old man noticed a lesion on his eyelid. It didn’t bother him, so he ignored it—until recently, when it reached a size sufficient to interfere with his vision. This development, and subsequent commentary from friends concerned by its proximity to his eye and fears of cancer, disturbed him enough to seek evaluation.
He first consulted an ophthalmologist, who provided a diagnosis that the patient promptly forgot. However, he was also advised to see a dermatologist or plastic surgeon for further evaluation, since the lesion does not affect the eye itself. The patient wants the lesion removed but seeks a dermatology referral first.
He denies pain, discomfort, or trauma to the affected area.
EXAMINATION
A translucent, round, 7-mm cystic lesion is located on the left lateral lower eyelid just below the margin, resembling a bleb. No redness is seen in the area. Palpation confirms the soft, cystic nature of the lesion.
Examination of the other eye and the rest of the patient’s facial skin reveals no abnormalities.
What is the diagnosis?
DISCUSSION
This is a typical presentation of an apocrine hidrocystoma (AH), a benign lesion of uncertain etiology. The eyelid is rich in apocrine, eccrine, and sebaceous glands, all of which can transform into cysts via traumatic plugging.
AH is also known as cystadenoma, Moll gland cyst, or sudoriferous cyst. It is an entity distinct from chalazions (a granulomatous reaction to sebaceous glands in the eyelid) and lacrimal duct cysts. The differential includes basal cell carcinoma, intradermal nevus, and eccrine cyst.
In my experience, merely incising and draining the cyst is useless in the long run; while this does reduce swelling, it also invites recurrence. Therefore, removal by saucerization and cauterization of the base is the best treatment option.
TAKE-HOME LEARNING POINTS
- Apocrine hidrocystomas (AHs) are benign cysts derived from plugged apocrine sweat glands, which are found in numerous areas around the body, including the eyes.
- AHs are also known as cystadenomas, Moll gland cysts, or sudoriferous cysts.
- Though AHs are often found near the eye, they are not technically an eye problem—but they do have potential to obstruct the visual field.
- Removal is usually by saucerization, with cautery of the base for hemostasis and prevention of recurrence.
