EyeRounds Online Atlas of Ophthalmology

Contributor: William Charles Caccamise, Sr, MD, Retired Clinical Assistant Professor of Ophthalmology, University of Rochester School of Medicine and Dentistry

*Dr. Caccamise has very generously shared his images of patients taken while operating during the "eye season" in rural India as well as those from his private practice during the 1960's and 1970's. Many of his images are significant for their historical perspective and for techniques and conditions seen in settings in undeveloped areas.

Category: Systemic Disorders

Xanthoma (xanthelasma) of the lids

All 4 lids are involved in this Caucasian male who is in his late 50s. The yellow plaques are composed of lipid-laden histiocytes. These lesions may or may not be related to blood-cholesterol disturbances. According to Stedman's Medical Dictionary 24th edition, the word xanthelasma is now considered archaic, xanthoma has replaced it.

another patient with xanthoma of the eyelids.

Xanthoma (xanthelasma) - left upper lid

Xanthelasma is a lesion composed of lipid-laden histiocytes, and may be a sign of hyperlipidemia. In this image, xanthelasma can be seen on the medial aspect of the upper lid, seen as the slightly-raised yellow-plaque. Currently, there are several approaches to cosmetically treat xanthelasma. One solution is the use of green laser; however, green laser cosmetic therapy for xanthelasma can result in depigmentation. As a result, green laser therapy for xanthelasma should be avoided in patients with highly pigmented skin. Alternatively, surgical excision or Ultrapulse CO2 ablation can be used to remove the plaques. Because xanthoma is a consequence of underlying hyperlipidemia, it is important to consider prescribing a lipid-lowering agent such as a statin or PCKS9 inhibitor.

Ophthalmic Atlas Images by EyeRounds.org, The University of Iowa are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.