BASAL CELL CARCINOMA: Basal cell carcinoma is the most common malignant tumor of the eyelids. Most of these carcinomas present as a nodular lesion with telangiectatic vessels at its borders. Larger lesions that outgrow their blood supply can ulcerate or can become umbilicated with smooth, pearly borders. Pigmented, cystic, and sclerosing basal cell carcinomas are less common than the nodular form seen here. Basal cell carcinoma occurs most often in fair-skinned individuals.

SQUAMOUS CELL CARCINOMA: Like basal cell carcinoma, most squamous cell carcinomas develop in fair-skinned individuals over the age of 50.Squamous cell carcinoma is a keratinized lesion, often affecting the eyelid margin. It can eventually extend into the orbit or spread via the regional lymph nodes. The risk of metastases of related to tumor size, depth of tumor invasion and degree of cellular differentiation. If a biopsy confirms the diagnosis of squamous cell carcinoma, surgical excision is performed with microscopic monitoring of tissue margins and eyelid reconstruction.
Two other lesions that may be mistaken for squamous cell carcinoma are actinic keratosis and carcinoma-in-situ of the skin. Actinic keratoses are usually but not always, premalignant lesions that should have excisional biopsy. These flat, scaly plaques have an erythematous base and can be confused with frank squamous cell carcinoma but are preinvasive lesions. Carcinoma-in-situ of the skin, sometimes called Bowen's disease, is an isolated, slightly elevated erythematous lesion with well-demarcated borders. Squamous carcinoma-in-situ cells have conspicuous eosinophilic cytoplasm, large aberrant nuclei, and prominent nucleoli. Once the malignant cells have invaded the underlying tissues, including basement membrane, the lesion is then defined as squamous cell carcinoma.

STURGE WEBER SYNDROME : Sturge-Weber syndrome is a rare congenital vascular condition characterized by a facial portwine stain, with or without leptomeningeal angiomatosis.The nevus flammeus of the face and/or eyelids corresponds to the distribution of th etrigeminal nerve. The conjunctival and choroidal vessels are usually engorged, and the raised episcleral venous pressure can produce glaucoma in one-third of these cases. Glaucoma associated with this syndrome can occur at any age, representing a significant visual threat often requiring surgery. A choroidal hemangioma is the most common intra-ocular abnormality associated with Sturge-Weber syndrome. The angioma of the pia and arachnoid often the vascular supply of the underlying cerebral cortex, leading to secondary degeneration and calcification.Treatment varies according to the location of the abnormality and the extent of ocular involvement.

CAPILLARY HEMANGIOMA: A capillary hemangioma usually appears at or soon after birth. This reddish purple tumor, sometimes called a strawberry nevus, tends to involute spontaneously within months or years, but it can become large enough to interfere within months or years, but it can become large enough to interfere within vision. Amblyopia can occur secondary to ptosis, strabismus, or astigmatism and anisometropia. A capillary hemangioma deep within the eyelid tissue or the orbit presents as a soft, bluish mass that often becomes more prominent when the child cries. Treatment is considered when normal visual development is affected or when marked deformity is observed. A current treatment preference is intra-lesional steroid injection.

ALLERGIC CONTACT DERMATITIS: Numerous environmental and externally applied agents, including a host of facial cosmetics and topical ophthalmic preparations, can affect the eyelids. Development of acute irritation, erythema, swelling and dry or wet scaling (eczema) of the skin around the lids, in association with application of a preparation to the periocular facial skin or the eye, suggests cell-mediated type IV hypersensitivity reaction. The agents most commonly associated with this immune reaction are sensitizing antibiotics (such as neomycin). Atropine is another common causative agent. If the inflammatory response is severe, treatment involves discontinuing the use of the offending agent and, occasionally, applying a topical corticosteroids ointment. However, if secondary bacterial infection is present, topical corticosteroids are contraindicated.