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What's the lesion on this boy's eyelid?

Dr Mike Wyndham was asked to look at this lesion almost as an afterthought by the child’s mother. He recalls how he made the diagnosis

 

The patient

This seven-year-old boy was brought in by his mother. She had come in for a Pill check and committed one of those unforgivable sins by asking if I wouldn't mind taking a quick look at his eye. She said the lesion was not painful and had been there for ‘a few weeks'.

First instinct

How many times do we hear ‘it will only take a second', take on the additional consultation and end up running late? This was further compounded that day by a computer system that had crashed. But it seemed like it was going to be a quick problem and so I took a look. My initial instinct was that there weren't many problems that could occur around the eye. Interestingly, the skin looked very dry and even split in one place. There was a lesion on the eyelid that was interfering with the growth of his eyelashes.

Differential diagnosis

• Meibomian cyst (chalazion)

• Stye (hordeolum)

• Molluscum contagiosum

Meibomian cysts tend to form a swelling in the eyelid that can be seen from outside. Occasionally, they may form on the lid margin but still originate from inside the eyelid. They are usually more common in adults than children. This seemed an unlikely diagnosis.

Styes develop at the base of an eyelash causing an inflamed/infected appearance.

They commonly cause pain and develop over a few days. This is quite contrary to the painless swelling this boy was suffering from and the amount of time that it had been present.

Molluscum contagiosum may appear on any part of the skin of a child. They develop as papules – some describe them like doughnuts – and have an umbilication at the centre. On the eyelid, they may cause a conjunctivitis or keratitis. There was the suspicion of a dip in the eye lesion but I wasn't 100% certain.

Getting on the right track

Meibomian cyst and stye seemed highly unlikely diagnoses, so my money was on molluscum.

The question was whether there was any other evidence to support the diagnosis. The skin was the clue. The patient didn't just have dry skin, he had eczema. Molluscum contagiosum has a habit of invading eczema and this proved to be the case here.

Dr Mike Wyndham is a GP in Edgware, north London

Lesion on the eyelid Lesion on the eyelid

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