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Open source ophthalmology education for students, residents, fellows, healthcare workers, and clinicians. Produced by the Moran Eye Center in partnership with the Eccles Library

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Home / Ophthalmic Pathology / Eyelids

Macroscopic Overview –Normal Eyelid:

The eyelid is comprised of several layers of tissue derived from surface ectoderm. From anterior to posterior, the layers are as follows: Skin, Muscle, Tarsus, and Conjunctiva.

Mamalis Eyelid 01 unlabeled  Mamalis Eyelid 01 labeled

Gross cross-section of eyelid

Mamalis Eyelid 02 unlabeled  Mamalis Eyelid 02 labeled

Trichrome stain of eyelid cross-section

Mamalis Eyelid 03 unlabeled  Mamalis Eyelid 03 labeled

H&E stain of eyelid

Mamalis Eyelid 04 unlabeled  Mamalis Eyelid 04 labeled

Tarsus and meibomian glands

Several dermatopathology terms are applicable to eyelid pathology.

Mamalis Eyelid 05 unlabeled  Mamalis Eyelid 05 labeled


Mamalis Eyelid 06 unlabeled  Mamalis Eyelid 06 labeled


Mamalis Eyelid 07 unlabeled  Mamalis Eyelid 07 labeled


Mamalis Eyelid 08 unlabeled  Mamalis Eyelid 08 labeled


All three general types of glands are present in the eyelid. The lid margin contains a higher concentration of these glands.

Mamalis Eyelid 09 unlabeled  Mamalis Eyelid 09 labeled

Eccrine-type lacrimal glands

Mamalis Eyelid 10 unlabeled  Mamalis Eyelid 10 labeled

Apocrine glands of Moll

Mamalis Eyelid 11 unlabeled  Mamalis Eyelid 11 labeled

Eyelashfollicle with sebaceous glands of Zeiss

Mamalis Eyelid 12 unlabeled  Mamalis Eyelid 12 labeled

Sebaceous Meibomian glands

Mamalis Eyelid 13 unlabeled  Mamalis Eyelid 13 labeled

Oil Red O Stain

Mamalis Eyelid 14 unlabeled  Mamalis Eyelid 14 labeled

Lid margin with several glands


Bacterial Infection


Mamalis Eyelid 15 unlabeled  Mamalis Eyelid 15 labeled

External photo

Mamalis Eyelid 16 unlabeled  Mamalis Eyelid 16 labeled


Mamalis Eyelid 17 unlabeled  Mamalis Eyelid 17 labeled

Acute Inflammatory Infiltrate

Preseptal Cellulitis

Verruca vulgaris

Molluscum contagiosum

Mamalis Eyelid 18 unlabeled  Mamalis Eyelid 18 labeled

External photo

Mamalis Eyelid 19 unlabeled Mamalis Eyelid 19 labeled

Molluscum contagiosum

Mamalis Eyelid 20 unlabeled  Mamalis Eyelis 20 labeled

Viral inclusion cysts


Mamalis Eyelid 21 unlabeled  Mamalis Eyelid 21 labeled


Mamalis Eyelid 22 unlabeled  Mamalis Eyelid 22 labeled

Bilateral chalazia

Mamalis Eyelid 23 unlabeled  Mamalis Eyelid 23 labeled

Lipogranulomatous reaction

Mamalis Eyelid 24 unlabeled  Mamalis Eyelid 24 labeled

Large, lipid-laden giant cell amongst chalazion contents


Mamalis Eyelid 25 unlabeled  Mamalis Eyelid 25 labeled


Mamalis Eyelid 26 unlabeled  Mamalis Eyelid 26 labeled

Lipid-laden histiocytes



Epidermoid Cyst

Mamalis Eyelid 27 unlabeled  Mamalis Eyelid 27 labeled

External photo

Mamalis Eyelid 28 unlabeled  Mamalis Eyelid 28 labeled

Keratin-filled epidermoid cyst

Mamalis Eyelid 29 unlabeled  Mamalis Eyelid 29 labeled

High magnification of cyst lining

Dermoid Cyst

Mamalis Eyelid 30 unlabeled  Mamalis Eyelid 30 labeled

Dermoid cyst

Mamalis Eyelid 31 unlabeled  Mamalis Eyelid 31 labeled

High magnification

Eccrine Hydrocystoma

Mamalis Eyelid 32 unlabeled  Mamalis Eyelid 32 labeled

External photo

Mamalis Eyelid 33 unlabeled  Mamalis Eyelid 33 labeled

Eccrine hydrocystoma

Apocrine Hydrocystoma

Mamalis Eyelid 34 unlabeled  Mamalis Eyelid 34 labeled

Apocrine hydrocystoma


Squamous Papilloma

Mamalis Eyelid 35 unlabeled  Mamalis Eyelid 35 labeled

Squamous papilloma

Mamalis Eyelid 36 unlabeled  Mamalis Eyelid 36 labeled

Low magnification

Mamalis Eyelid 37 unlabeled  Mamalis Eyelid 37 labeled

High magnification

Mamalis Eyelid 38 unlabeled  Mamalis Eyelid 38 labeled

Cross-section of fibrovascular cores

Seborrheic Keratosis

Mamalis Eyelid 39 unlabeled  Mamalis Eyelid 39 labeled

Seborrheic keratosis

Mamalis Eyelid 40 unlabeled  Mamalis Eyelid 40 labeled

Keratin whirls

Mamalis Eyelid 41 unlabeled  Mamalis Eyelid 41 labeled

Pigmented melanocytes

Nick’s tips: In seborrheic keratosis, there are finger-like projections of epidermis that go into the dermis, so it takes on more of a “hairy spider” appearance. However, in squamous papilloma, fibrovascular cores project up or out from the dermis into the epidermis, taking on a “gloved hand” morphology.



Mamalis Eyelid 42 unlabeled  Mamalis Eyelid 42 labeled


Actinic Keratosis

Mamalis Eyelid 43 unlabeled  Mamalis Eyelid 43 labeled

Actinic keratosis

Mamalis Eyelid 44 unlabeled  Mamalis Eyelid 44 labeled

Solar elastosis

Mamalis Eyelid 45 unlabeled  Mamalis Eyelid 45 labeled

Keratin whirls and atypia

Nick’s tips: Since the basement membrane in actinic keratosis is still intact, it is essentially like carcinoma in situ of the eyelid. Make sure to include the base of the lesion in the biopsy so an invasive squamous cell carcinoma can be ruled out.

Basal Cell Carcinoma (BCC)

Mamalis Eyelid 46 unlabeled  Mamalis Eyelid 46 labeled

Ulcerated BCC

Mamalis Eyelid 47 unlabeled  Mamalis Eyelid 47 labeled

Nodular BCC

Mamalis Eyelid 48 unlabeled  Mamalis Eyelid 48 labeled

Peripheral palisading

Mamalis Eyelid 49 unlabeled  Mamalis Eyelid 49 labeled

High magnification

Mamalis Eyelid 50 unlabeled  Mamalis Eyelid 50 labeled

Nodulocystic BCC

Mamalis Eyelid 51 unlabeled  Mamalis Eyelid 51 labeled

Morpheaform BCC

Mamalis Eyelid 52 unlabeled  Mamalis Eyelid 52 labeled

Basosquamous BCC

Mamalis Eyelid 53 unlabeled  Mamalis Eyelid 53 labeled

Differentiated Adenoid BCC

Squamous Cell Carcinoma(SCC)

Mamalis Eyelid 54 unlabeled  Mamalis Eyelid 54 labeled

Nodule of SCC

Mamalis Eyelid 55 unlabeled  Mamalis Eyelid 55 labeled

Diffuse SCC lesion

Mamalis Eyelid 56 unlabeled  Mamalis Eyelid 56 labeled

Squamous cell carcinoma

Mamalis Eyelid 57 unlabeled  Mamalis Eyelid 57 labeled

Higher magnification

Nick’s tips: When in doubt, a basal cell carcinoma is predominantly blue, whereas a squamous cell carcinoma will predominantly stain pink due to the presence of keratin.

Sebaceous Hyperplasia

Mamalis Eyelid 58 unlabeled  Mamalis Eyelid 58 labeled

Sebaceous hyperplasia

Sebaceous Adenoma

Mamalis Eyelid 59 unlabeled  Mamalis Eyelid 59 labeled

Sebaceous adenoma

Sebaceous Carcinoma

Mamalis Eyelid 60 unlabeled  Mamalis Eyelid 60 labeled

Diffuse Sebaceous carcinoma

Mamalis Eyelid 61 unlabeled  Mamalis Eyelid 61 labeled

Focal sebaceous carcinoma

Mamalis Eyelid 62 unlabeled  Mamalis Eyelid 62 labeled

Low magnification

Mamalis Eyelid 62 unlabeled  Mamalis Eyelid 63 labeled

High magnification with mitotic figures

Mamalis Eyelid 64 unlabeled  Mamalis Eyelid 64 labeled

Oil Red O stain

Nick’s tips: A diffuse sebaceous carcinoma can mimic blepharoconjunctivitis, whereas a focal lesion can be confused with a recurrent chalazion clinically. Any loss of lashes should alert you to a more insidious process occurring.

Nevus of the Eyelid (Junctional, Compound, Intradermal)

Mamalis Eyelid 65 unlabeled  Mamalis Eyelid 65 labeled

Nevus of the eyelid margin

Mamalis Eyelid 66 unlabeled  Mamalis Eyelid 66 labeled

Compound nevus

Mamalis Eyelid 67 unlabeled  Mamalis Eyelid 67 labeled

Dermal nevus

Melanoma of the Eyelid

Mamalis Eyelid 68 unlabeled  Mamalis Eyelid 68 labeled

Melanoma of the eyelid

Mamalis Eyelid 69 unlabeled  Mamalis Eyelid 69 labeled

Low magnification

Mamalis Eyelid 70 unlabeled  Mamalis Eyelid 70 labeled

High magnification


Mamalis Eyelid 71 unlabeled  Mamalis Eyelid 71 labeled

External photo

Mamalis Eyelid 72 unlabeled  Mamalis Eyelid 72 labeled

Lymphoma of the Eyelid

Merkel Cell Carcinoma

Mamalis Eyelid 73  Mamalis Eyelid 73 labeled

External photo


Merkel Cell Carcinoma

Mucinous Adenocarcinoma

Mamalis Eyelid 75 unlabeled  Mamalis Eyelid 75 labeled

Mucinous adenocarcinoma

Mamalis Eyelid 76 unlabeled  Mamalis Eyelid 76 labeled

Mucicarmine stain

Capillary Hemangioma

Mamalis Eyelid 77 unlabeled  Mamalis Eyelid 77 labeled

Late Capillary hemangioma

Mamalis Eyelid 78 unlabeled  Mamalis Eyelid 78 labeled

High magnification


Mamalis Eyelid 79 unlabeled  Mamalis Eyelid 79 labeled



Harper RA. Basic Ophthalmology. Amer Academy of Ophthalmology; 2010.

Yanoff M, Fine BS. Ocular Pathology, A Text and Atlas. Lippincott Williams & Wilkins; 1989.