There's a Growth on My Eyelid: Conjunctival Concretions

Have you ever pulled down your eyelid and looked closely at the tissue underneath?  For most of us, the only reason to look under your eyelid is if it feels like there is something stuck underneath.  But not everything that you see within your conjunctival tissue (the vascular layer that makes up the underside of your eyelid) is a foreign body or stye.  Imagine if you pulled your eyelid down and saw this:

Inferior tarsal conjunctival concretions via

Do you see all of those whitish yellow growths on the underside of the eyelid?  Those are conjunctival concretions.  Good news: concretions are a completely benign entity and hardly ever cause irritation or discomfort.  Many, many people have them (I see them in patients every single day), and typically your doctor will not mention them because they are harmless.  But if you have never noticed them before, and see them all of a sudden when feeling irritation under your eyelid, it can definitely cause concern.  Hopefully you have found this blog so I can put your mind at ease. 

What are Concretions?

Concretions are really a variant of inclusion cysts, where keratin debris becomes trapped within the conjunctival tissue (read more here).  This debris is typically thought to be from epidermal (skin) tissue, but there is evidence that there are also mucin and granular tissue found within most concretions as well.  This histology leads to our current idea of how concretions are formed: epithelial (skin) debris gets trapped in conjunctival mucin (the conjunctiva is a mucus membranous vascular layer that covers the eye and internal eyelid), and then embeds within the conjunctival tissue permanently.  People can have concretions for a variety of reasons, but they are most commonly associated with chronic irritation/allergies, and aging.  Patients with seasonal allergies or giant papillary conjunctivitis (where you are allergic to contact lens wear) are my most typical patients where I see concretions.  

Treatment

The presence of concretions speaks to recurrent eyelid irritation, and tells your doctor that you have been suffering from bouts of irritation for years and years.  Their presence may help guide your doctor that you need treatment for your ocular irritation since you are apparently a recurrent sufferer, and using steroid drops or allergy eye drops can help prevent further irritation and further concretion development.  There is no way to remove or get rid of concretions using an eye drop, but luckily they don't often need to be removed.

The concretions themselves are typically embedded quite deeply into the conjunctival tissue, so that there is no rubbing or foreign body sensation as you blink and they run across your eye.  In rare occasions, the concretion may be elevated or too exposed to the surface, and thus can cause irritation. In these incidences, they can be surgically removed.  If you are curious, the YouTube video below shows the process.  Remember, concretions are embedded in the conjunctiva so removing them will cause some bleeding as you break through the vascular tissue to dig it out.  If the concretions aren't bothering the eye, then it is obviously preferable to leave them alone.  

Take Home

If you see a growth or bump on your eyelid, I always recommend that you consult with your eye doctor to make sure it is normal, or have it treated if it is an infection or cancerous growth.  But there are so many normal eyelid and eye growths that you may see and seek internet guidance for (conjunctival cysts are my most popular post all-time!), so I will keep posting to the blog about any possible eye findings, no matter how "boring" or normal they may be.  It is always great to hear that something you are worried about is actually 100% harmless.