Quick answer
Xanthelasma are soft, yellowish cholesterol plaques that form on the eyelids, usually near the inner corner. They are entirely benign and painless, but many people find them cosmetically undesirable. Around half of those affected have raised blood cholesterol, so a lipid check is recommended. They can be removed surgically or with other techniques.
What is Xanthelasma?
Xanthelasma are flat or slightly raised yellowish plaques that develop on the eyelids — most commonly on the inner upper lid. They are made up of lipid-filled macrophages (foam cells) in the dermis and are the most common form of xanthoma. While they are entirely benign and cause no visual symptoms, many patients find them cosmetically undesirable. Approximately 50% of people with xanthelasma have elevated serum cholesterol or triglycerides, so systemic lipid investigation is always recommended.
What are the symptoms of Xanthelasma?
- Yellowish flat or slightly raised plaques on the inner corners of the upper or lower eyelids
- Usually bilateral and symmetrical
- No pain, itch or visual disturbance
- Tendency to slowly enlarge over time
What causes Xanthelasma?
- Hyperlipidaemia (elevated cholesterol or triglycerides) — present in ~50% of cases
- Familial hypercholesterolaemia
- Diabetes mellitus
- Normal lipid levels in the remaining 50% — mechanism not fully understood
How is Xanthelasma diagnosed?
Clinical diagnosis on inspection. Fasting lipid profile, blood glucose and liver function tests should be arranged to exclude systemic dyslipidaemia. Referral to a lipidologist or GP for cardiovascular risk assessment.
How is Xanthelasma treated?
Xanthelasma do not require treatment if the patient is not bothered by them. Cosmetic removal options include surgical excision (the most reliable method), carbon dioxide laser ablation, trichloroacetic acid chemical peel, and cryotherapy. Surgical excision by an oculoplastic surgeon provides the most predictable result. Recurrence can occur, particularly if the underlying lipid abnormality is not controlled.
Frequently asked questions
Are xanthelasma dangerous?
No. Xanthelasma are benign cholesterol deposits and cause no pain or visual problems. However, around half of people with them have elevated cholesterol or triglycerides, so a fasting lipid check and cardiovascular risk assessment are recommended even though the lesions themselves are harmless.
How are xanthelasma removed?
Options include surgical excision (the most reliable method), carbon dioxide laser, trichloroacetic acid chemical peel, and cryotherapy. Surgical excision by an oculoplastic surgeon gives the most predictable result. Removal is a cosmetic procedure and is not usually required on medical grounds.
Do xanthelasma come back after removal?
Recurrence can occur, particularly if an underlying lipid abnormality is not controlled. Addressing raised cholesterol with your GP and following lipid-lowering advice reduces the risk. Even so, some patients develop new lesions over time and may choose to have them treated again.
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