Eyelid tumors are commonly diagnosed in geriatric veterinary patients and can lead to secondary ocular complications, local invasion, and/or metastasis. Eyelid tumors can dramatically differ in behavior and treatment strategies between dogs and cats.
Meibomian gland tumors are usually first noticed arising from the eyelid margin because they travel the path of least resistance to the meibomian gland orifice, but they can also erupt through the palpebral conjunctiva (FIGURE 1). They commonly have a cobblestone surface and can be pink, tan, gray, or black (FIGURE 2).5 Sebaceous gland tumors can include meibomian gland tumors as well as accessory gland tumors arising from the periocular skin.3 Papillomas are often distinctive due to their exophytic nature, arising from the eyelid margin (FIGURE 3), the adjacent dermis, or the conjunctiva; their origin can be viral or nonviral (squamous).5,6 Melanocytic tumors of the eyelid can be divided into 3 distinct types: a pigmented pedunculated mass arising from the dermis, which can be excised without concern for margins and is associated with a low rate of recurrence; a pigmented mass arising from the eyelid margin and expanding in both directions, which is more locally invasive than the dermal version and thus benefits from adjunctive treatment such as cryotherapy; and a pigmented or nonpigmented mass arising from the conjunctiva, which is malignant and requires more aggressive treatment.4
In cats, a squamous cell carcinoma is best managed by complete excision with wide (4 to 5 mm) surgical margins, which can sometimes dictate enucleation of a visual, healthy eye.10 Ways to help manage the missing tissue include creating a lip-to-lid subdermal plexus flap, a local transposition flap, or a caudal auricular axial pattern flap.20-22 When resection alone will not slow tumor progression, debulking combined with adjunctive therapy can be used. Adjunctive therapies include cryotherapy, beta radiation therapy (local strontium-90), photodynamic therapy, and electrochemotherapy;10,14,23 however, none of these treatments penetrates deep into the tissue. Peripheral nerve sheath tumors usually require removal of wide surgical margins, involving removal of the eye, because nearly all conservatively treated tumors will recur.10 Fortunately, mast cell tumors often respond well to surgical removal, even with incomplete margins.11 Apocrine hidrocystomas can be incised, drained, and then treated with cryosurgery or photoablation if the masses are causing irritation to the patient. Alternatively, drainage and injection with polidocanol can be effective. Although these tumors are benign, recurrence or formation of new cysts is common; thus, benign neglect is an option for masses not causing a clinical concern.
Most eyelid tumors are associated with clinical features and characteristics that can support a presumptive diagnosis and guide the clinician to the next step. However, sometimes a fine-needle aspirate or punch biopsy can be helpful for formulating a diagnostic and treatment plan, especially for masses that do not have a typical appearance or are suspected to be malignant. Thus, these diagnostics are most often used for cats or for tumors arising from the dermis or conjunctiva in dogs before formulating a surgical plan. Because only histologic examination can reveal the definitive diagnosis, all resected tumors should be submitted for histopathology, even if suspected to be benign.
In general, eyelid neoplasia is best treated early, when the tumor is small, because the amount of tissue that can be removed without extensive reconstruction is finite. Typically, 25% to 33% of the eyelid length can be removed while still enabling primary closure; however, this percentage is highly variable, depending on the breed conformation.18 Before surgery, eyelids should be washed with dilute baby shampoo to remove dirt, after which a 1:50 dilution of povidone-iodine solution can be applied to the eyelids and conjunctival fornix with cotton-tipped applicators. The patient should be in sternal position with the head straight and the palpebral fissure horizontal. Drapes should be secured in such a way that they do not distort the eyelids. During closure, suture material should never pass through the conjunctiva, all knots and tags should point away from the eyelid margin and palpebral conjunctiva, and 5-0 or 6-0 soft sutures (e.g., silk or polyglactin 910) should be used. Use of an Elizabethan collar is essential to prevent self-trauma, which can lead to loosened sutures, wound dehiscence, and/or infection.4
Treatment of Eyelid Tumors in Dogs
The removal of an eyelid tumor can be done using two different techniques.
Cryotherapy
This procedure involves using a local anesthetic and removing as much of the tumor as possible. Then, cryotherapy is used to freeze the site of the tumor to kill any of the tumor cells that were left behind. Cryotherapy may need to be repeated if the tumor continues to grow.
Surgical Removal
This procedure involves anesthetizing and then removing a wedge of tissue, including the tumor, and then suturing the lid closed. By removing the surrounding tissue along with the tumor, it is hoped that all the tumor’s cells are also removed. This procedure is especially used for large tumors. Any surgical procedure involving the eye is very complex. Your veterinarian may decide to refer you to a specialized canine ophthalmologist.
Worried about the cost of Eyelid Tumors treatment?
Pet Insurance covers the cost of many common pet health conditions. Prepare for the unexpected by getting a quote from top pet insurance providers.
Symptoms of Eyelid Tumors in Dogs
If you notice a growth on your dog’s eyelid, have it checked out by your veterinarian. These eyelid tumors many times appear on the edge of the eyelid. They can vary in size, but all need to be thoroughly checked out by your veterinarian. You may not be able to clearly see a growth on the eyelid if it is very small so there are other symptoms to watch for.
Natural Treatment for Dog Eyelid Tumor
Eyelid tumors are commonly diagnosed in geriatric veterinary patients and can lead to secondary ocular complications, local invasion, and/or metastasis. Eyelid tumors can dramatically differ in behavior and treatment strategies between dogs and cats.
The primary roles of the eyelids are to protect the globe, produce glandular secretions from the meibomian glands and conjunctival goblet cells, and distribute tears across the cornea. An irregular eyelid margin secondary to an eyelid tumor can lead to complications that impair these functions. When the examiner first observes an eyelid tumor, the following things should be considered for planning the type and timing of treatment:
The most common eyelid tumors in dogs are sebaceous (meibomian) adenomas (29% to 37%), sebaceous (meibomian) epitheliomas (17% to 34%), sebaceous (meibomian) hyperplasia (18%), sebaceous (meibomian) adenocarcinomas (5% to 15%), papillomas (2% to 17%), melanocytomas/melanomas (2% to 21%), and histiocytomas (1% to 4%).1,2 Note that some, but not all, pathologists differentiate sebaceous hyperplasia from sebaceous adenomas.3 Note also that adenocarcinomas are considered rare, and older data probably misclassified epitheliomas into this category, resulting in increased reporting of adenocarcinomas. Overall, eyelid tumors of dogs are at least 3 to 8 times more likely to be benign than malignant.1,4
Meibomian gland tumors are usually first noticed arising from the eyelid margin because they travel the path of least resistance to the meibomian gland orifice, but they can also erupt through the palpebral conjunctiva (FIGURE 1). They commonly have a cobblestone surface and can be pink, tan, gray, or black (FIGURE 2).5 Sebaceous gland tumors can include meibomian gland tumors as well as accessory gland tumors arising from the periocular skin.3 Papillomas are often distinctive due to their exophytic nature, arising from the eyelid margin (FIGURE 3), the adjacent dermis, or the conjunctiva; their origin can be viral or nonviral (squamous).5,6 Melanocytic tumors of the eyelid can be divided into 3 distinct types: a pigmented pedunculated mass arising from the dermis, which can be excised without concern for margins and is associated with a low rate of recurrence; a pigmented mass arising from the eyelid margin and expanding in both directions, which is more locally invasive than the dermal version and thus benefits from adjunctive treatment such as cryotherapy; and a pigmented or nonpigmented mass arising from the conjunctiva, which is malignant and requires more aggressive treatment.4
A differential diagnosis for an eyelid swelling in a dog is a chalazion caused by blockage of the meibomian gland duct (often but not always caused by a meibomian gland tumor) and inspissation of meibum, sometimes resulting in gland rupture, causing a lipogranuloma (FIGURE 4).7
Up to 91% of eyelid tumors in cats are malignant;8,9 thus, they require a more urgent diagnostic and treatment plan. The most common eyelid tumors of cats are squamous cell carcinomas (28% to 65%), mastocytomas (3% to 26%), hemangiosarcomas (2% to 14%), lymphomas (7% to 11%), adenocarcinomas (4% to 9%), peripheral nerve sheath tumors (7%), fibrosarcomas (5%), and apocrine hidrocystomas (3% to 7%). Squamous cell carcinomas develop secondary to ultraviolet light exposure; they start off as an erythematous region of the eyelid margin, progress to ulceration with a crusted surface (FIGURE 5), and then progress further to a deep erosion (FIGURE 6). Local invasion can be extensive if not addressed early in the disease process, and tumor recurrence is very common.10 Mast cell tumors appear as single, pink, hairless, raised, and sometimes ulcerated masses near the eyelid margin.11 Hemangiosarcomas of the eyelid appear as a red fleshy mass, sometimes with an ulcerated surface.12 Peripheral nerve sheath tumors are low-grade subcutaneous spindle cell tumors that are locally invasive but unlikely to metastasize.10 Apocrine hidrocystomas appear as black round periocular masses, most common in Persian cats.10