A type of planar xanthoma, xanthelasma consists of single or multiple soft, yellow plaques that occur in the medial canthal region of the eyelids (Fig 13-8A). Associated hyperlipoproteinemic states, particularly hyperlipoproteinemia types II and III, are present in 30%–40% of patients with xanthelasma. Associated inflammatory signs are minimal. Histologically, eyelid xanthomas consist of aggregates of histiocytes with foamy, lipid-laden cytoplasm distributed diffusely and often around blood vessels within the dermis (Fig 13-8B). The histiocytes are postulated to phagocytose lipid that leaks from the blood vessels in the eyelid, although why the eyelid is often affected remains unclear.
Excerpted from BCSC 2020-2021 series: Section 4 - Ophthalmic Pathology and Intraocular Tumors. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.