The most common lump presenting in children is a chalazion. This is a benign mass but it can cause irritation symptoms like eye redness, sticky lids, and mild tearing. A chalazion is a collection of lipogranulomatous inflammatory tissue as a result of a blocked meibomian gland duct, a structure in the eyelid. It usually presents as a localized painless nodule in the lid or lid margin, with or without a swollen red lid. Small chalazion resolves spontaneously, so it need not be excised. Warm compresses several times a day with baby shampoo eyelid washes twice per day helps drain the lipid material, decompressing the chalazion. Topical antibiotics can be useful if inflamed. Larger chalazion may need incision and curettage under general anaesthesia. Chronic chalazion that does not respond to several weeks of treatment warrants a suspicion of malignancy.
Another benign lid mass in small children is a stye or external hordeolum. A stye is a painful abscess of the sebaceous gland of the lid often associated with Staphylococcus aureus. The stye may resolve spontaneously, but antibiotic ointment is helpful in relieving some of the discomfort. Children with larger abscesses require systemic antibiotics, incision and drainage under anaesthesia.
As in all young children with a lump in the lid of any cause, the risk of amblyopia by distortion of the globe or partial occlusion of the visual axis must not be overlooked. It is important to monitor the visual acuity of children with very large lumps in the lid.