Natural fats, including cholesterol, can form growths around the eyelids. One of these growths is called a xanthelasma (zan-the-laz-mah). Several growths together are called xanthelasmata.
A xanthelasma may have no cause. However, it can sometimes indicate high cholesterol, hypothyroidism, or a liver condition.
In this article, we look at the symptoms, causes, diagnosis, and treatment of cholesterol deposits on the eyes.
Xanthelasmata can indicate high cholesterol.
Image credit: Klaus, D. Peter, 2005
Cholesterol deposits are soft, flat, yellowish lumps. They tend to appear on the upper and lower eyelids, near the inner corner of the eye, and often develop symmetrically around both eyes.
These lesions may remain the same size or grow very slowly over time. They sometimes join together to form larger lumps.
Xanthelasmata are not usually painful or itchy. They rarely affect vision or eyelid movement but sometimes cause the eyelid to droop.
Cholesterol deposits can appear at any age but are more likely to develop during a person's middle years. They are more common in women than men.
The medical community is unsure about the exact cause of these deposits. However, having a xanthelasma is associated with abnormal lipid levels in the blood, which is known as dyslipidemia.
A person is diagnosed with dyslipidemia if they have:
- high levels of low-density lipoprotein (LDL) cholesterol — "bad" cholesterol
- low levels of high-density lipoprotein (HDL) cholesterol — "good" cholesterol
- high levels of total cholesterol (both LDL and HDL)
- high levels of triglycerides
Dyslipidemia increases the risk of cholesterol building up on the walls of arteries. This buildup can restrict blood flow to the heart, brain, and other areas of the body. It also increases the risk of angina, heart attack, stroke, and peripheral arterial disease.
Dyslipidemia is linked to inherited genetic disorders, including:
- familial hypercholesterolemia
- familial hypertriglyceridemia
- lipoprotein lipase deficiency
A person with one of these conditions may have abnormally high lipid levels despite being in otherwise good health. For this reason, these conditions are known as primary causes of dyslipidemia.
Secondary causes of dyslipidemia may include a diet high in saturated fat and cholesterol.
Secondary causes include lifestyle factors, such as:
- a diet high in saturated fats and cholesterol
- being overweight or obese
- not getting enough exercise or physical activity
- consuming alcohol excessively
- smoking tobacco products
Other risk factors for dyslipidemia include:
- chronic kidney disease
- high blood pressure
- primary biliary cirrhosis and some other liver disorders
- a family history of stroke or heart disease
- certain medications, including beta-blockers, oral contraceptives, retinoids, and anabolic steroids
One study found that cholesterol deposits on the eyelids were associated with increased risk of heart attack and heart disease, even in people with normal lipid levels.
People with cholesterol deposits should see a doctor to have their lipid levels checked.
Xanthelasmata are usually simple to diagnose with a visual examination. If the doctor is unsure, they may send a scraping or sample to a laboratory for analysis.
The doctor may also test for diabetes and liver function, and possibly recommend a formal cardiovascular risk assessment.
Regular exercise may help to lower levels of LDL cholesterol and triglycerides.
Cholesterol deposits around the eyes can be surgically removed. The growths usually cause no pain or discomfort, so a person will likely request removal for cosmetic reasons.
The method of removal will depend on the size, location, and characteristics of the deposit. Surgical options include:
- surgical excision
- carbon dioxide and argon laser ablation
- chemical cauterization
Following a procedure, there may be swelling and bruising around the eyelids for a few weeks. Risks of surgery include scarring and a change in the skin's color.
Cholesterol deposits are very likely to reoccur following removal, especially in people with high cholesterol.
Normalizing lipid levels will have almost no effect on existing deposits. However, treating dyslipidemia is essential, because it can reduce the risk of heart problems. Treatment may also prevent more deposits from developing.
A doctor usually treats dyslipidemia by recommending lifestyle and dietary modifications. A doctor or dietitian can help to develop a plan that works for each individual.
Possible recommendations include:
Being overweight or obese can raise LDL cholesterol and triglyceride levels. Healthful methods of losing weight can help overweight people with dyslipidemia.
Eating a healthful diet
An individual with dyslipidemia should eat a balanced diet low in saturated fats, trans fats, and cholesterol. A doctor or dietician will likely recommend eating more fruits, vegetables, and whole grains. These foods are low in fat and contain no cholesterol.
Foods to avoid include:
- whole milk
- butter, cheese, and cream
- fatty meats and lard
- cakes and cookies
- foods containing coconut or palm oil
A person should consume healthful fats instead. These can be found in oily fish, nuts, seeds, and vegetable oils and spreads.
Foods rich in soluble fiber can also help to lower cholesterol. These include:
- beans, lentils, and other pulses
- oats and barley
- wholegrain rice
- citrus fruits
Regular physical activity is also essential in treating dyslipidemia. It can help to raise levels of HDL cholesterol, and lower levels of LDL cholesterol and triglycerides.
Activities such as brisk walking, cycling, swimming, and running can also improve cardio health and help someone to maintain healthy body weight.
Reducing alcohol consumption
Drinking too much alcohol can increase cholesterol and triglyceride levels. The United States Dietary Guidelines for Americans recommends that women consume no more than one alcoholic drink per day and men no more than two.
A single alcoholic drink is defined as:
- 12 fluid ounces (fl. oz) of regular beer, containing 5 percent alcohol
- 5 fl. oz of wine with 12 percent alcohol
- 1.5 fl. oz of 80-proof distilled spirits with 40 percent alcohol
Smoking tobacco products can raise LDL cholesterol and inhibit the positive effects of HDL cholesterol. A person with dyslipidemia who smokes should talk to a doctor about ways to quit.
Taking lipid-lowering medications
A doctor may also prescribe a lipid-lowering medication, such as a statin, ezetimibe, or niacin.
Cholesterol deposits around the eye are known as xanthelasmata. They are usually harmless and do not affect vision or the functioning of the eyelid. However, some people may wish to have them surgically removed for cosmetic reasons.
A xanthelasma is sometimes a symptom of a more serious underlying condition, such as dyslipidemia, hypothyroidism, kidney disease, liver disease, or diabetes.
Anyone developing cholesterol deposits around the eyes should speak to a doctor.