DEAR DR. K: I have small white bumps on my eyelids that drive me crazy. They don’t hurt, but they look awful. A doctor told me they are meibomian cysts. He said they are harmless, but if I want to get rid of them, I’ll need surgery. What do you think?
DEAR READER: These little cysts are harmless in one respect: They are not a form of cancer. But I wouldn’t call them harmless if they bother you every time you catch a glimpse of yourself in the mirror.
First, let’s be sure that you actually have meibomian cysts. Since I can’t look at your eyelids, I’m not sure if your bumps are large or small. Nor do I know exactly where they appear on your eyelids. Just as in real estate, location counts.
Meibomian cysts are small, fluid-filled sacs that can develop along the edge of an eyelid. They take their name from the meibomian glands, which produce a mixture of oil and mucus to keep your skin and hair, including eyelashes, from drying out. The fluid is released through tiny openings called ducts peppered along the edge of the eyelid, just behind the eyelashes.
When a duct gets blocked, fluid backs up into the gland. This prompts inflammation and produces a cyst that grows toward the inner surface of the eyelid. The cyst is small and white, as you describe.
Often, meibomian cysts disappear without any treatment at all. Failing this, I recommend putting a warm compress on the area. Apply it for 10 to 20 minutes, three to four times a day. This gentle treatment encourages the cyst to drain and heal. If a cyst becomes infected, I generally prescribe an antibacterial ointment. Sometimes a cyst won’t respond to compresses or becomes very large. At this point, surgery may be needed. Ask your doctor to refer you to an eye specialist who specializes in eyelid surgery and can drain or remove the cyst.
There are other types of little bumps on the eyelids that require different treatments.
Another possibility is that you have milia. Milia are tiny, white dome-shaped bumps. They form on the skin of the eyelid or around the eye. Milia are much smaller than meibomian cysts — about the size of pinheads. They may not look good, but they don’t hurt and don’t interfere with vision.
Finally, although it is rare, some types of skin cancer can start on the eyelids. Here are my “red flag” signs for eyelid bumps. If you answer “yes” to any of these questions, get checked out by a dermatologist or ophthalmologist experienced in handling eyelid conditions:
Are the bumps red and painful? Are they growing larger? Do they have a brown or black color?
If your eyelid bumps bother you, or if they show any of my red-flag warning signs, get them checked out. While your bothersome bumps may not disappear in a blink, the right doctor should be able to help.