Photo Rounds

Growths on eyelids

A 59-year-old woman went to her family physician (FP) because she was concerned about some growths on her eyelids. They first appeared a year earlier and had continued to grow larger. While the patient had growths on both eyelids, they were worse on the left side. The patient typically saw her FP for diabetes and hypertension, but her top priority at this visit was the appearance of her eyelids. She said the growths were not painful or itchy, but they were beginning to affect her vision.

What’s your diagnosis?


 

The FP diagnosed skin tags (acrochordons) on her eyelids and explained that they were not dangerous. Removal options include cryotherapy, snip excisions, and electrosurgery.

The safest method of cryotherapy in a case like this is to use Cryo Tweezers. (See a video on how to perform cryosurgery here.) Using a cryo-spray in this area could result in the treatment getting into the eye.

Cryo Tweezers can apply cold to the skin tags without risking damage to the eye. The Cryo Tweezers are made cold by dipping them into liquid nitrogen. Then, each skin tag is grasped while gently pulling it away from the orbit. The skin tag is held between the 2 ends of the tweezer until it turns white. This method is very safe and causes very little discomfort to the patient.

Snip excisions on the eyelid are challenging for a number of reasons, including the fact that aluminum chloride or other chemical hemostatic agents are not safe for the eye. Electrosurgery can be performed with a loop electrode but only after the skin tags are numbed by injecting a local anesthetic into the eyelids. While it is possible for this to be performed safely, it is more challenging than using the Cryo Tweezers, which do not require a local anesthetic.

The patient in this case chose Cryo Tweezers for treatment and tolerated it well. The FP also documented that the patient believed the skin tags were affecting her vision in an effort to increase the likelihood that her insurance would cover the procedure. At a follow-up appointment 2 months later for the patient’s diabetes, the skin tags on her eyelids had resolved.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Smith AM. Skin tags. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013: 922-925.

To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com

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