American Melanoma Institute · 5 min read
How UV light harms the eyes and eyelids, how to pick sunglasses that protect, and how eyelid skin cancers look and are treated.
Eyelid skin is the thinnest skin on the body, and it faces the sun every day of your life. Most people never put sunscreen on it. The eye behind it takes UV damage too, in ways that build slowly over many years.
About 5% to 10% of all skin cancers occur on the eyelids, according to a review from the MD Anderson Cancer Center (Yin and colleagues, Clinics in Dermatology, 2015).
Basal cell carcinoma makes up the great majority, more than 90% of eyelid cancers in some series. It turns up most often on the lower lid, which catches more sun than the upper lid, and next most often at the inner corner of the eye. Squamous cell carcinoma comes second. Sebaceous carcinoma (a cancer of the oil glands in the lid), melanoma, and Merkel cell carcinoma are all rare here.
Eyelid cancers are usually painless and slow-growing. A stye or chalazion that does not clear up within a few weeks, or that returns in the same spot, deserves a look from a doctor. Other signs to report:
A cataract is a clouding of the lens, the clear disc that focuses light inside the eye. Years of UV exposure make certain types of cataract more likely. Surgery restores vision.
A pterygium, sometimes called surfer's eye, is a wedge of fleshy tissue with blood vessels that grows from the white of the eye toward the cornea, the clear front window. The American Academy of Ophthalmology ties it to a combination of UV light, wind, and dust. It causes redness and irritation, and it can blur vision if it grows over the cornea. Eye drops ease the symptoms, and surgery removes a growth that causes trouble.
Photokeratitis is a sunburn of the cornea. It follows a few hours of intense UV, most often reflected from snow (snow blindness), water, or sand, or from a welding arc or tanning bed without eye protection. The eyes turn red, watery, gritty, and very sensitive to light. Symptoms commonly last 6 to 24 hours and nearly always clear within 48 hours. Pain that lasts beyond 2 days, or any loss of vision, needs an eye exam.
One thing on the label matters most. Look for "100% UV protection," "100% UVA and UVB protection," or "UV400," which means the lenses absorb UV up to 400 nanometers and therefore cover both UVA and UVB.
Dark lenses are no guide. The tint controls how much visible light gets through, and the UV filter is a separate, clear feature of the lens. Price is no guide either. The American Academy of Ophthalmology points out that drugstore sunglasses labeled 100% UV-blocking are a better choice than designer frames without that label.
A hat with a brim all the way around shades the eyes and lids from overhead sun. Sunglasses block light from the front, and the hat blocks what comes over the top of the frame.
The eyelids and the skin next to the nose are among the spots people most often miss with sunscreen. Mineral sunscreens made with zinc oxide or titanium dioxide, and stick sunscreens that stay where you put them, tend to sting less if they drift toward the eye.
UV damage to the eyes and lids adds up over a lifetime, so eye protection is a habit to start early. The same label rule applies to children's sunglasses: 100% UV protection or UV400. A brimmed hat covers the times a small child refuses to wear them. Babies under 6 months belong in the shade.
Surgery is the main treatment. The surgeon has to remove all of the cancer while sparing normal tissue, because the lid protects the eye and spreads tears across it. Doctors therefore favor methods that check the edges of the removed tissue during the operation. One is Mohs surgery, in which the surgeon removes the tumor in thin stages and examines each one under the microscope until no cancer remains. The other is excision with frozen-section margin checks by a pathologist.
Once the cancer is out, the lid is rebuilt. Small gaps close with a few stitches. Larger ones may need a skin graft or a flap of nearby tissue, and an oculoplastic surgeon (an ophthalmologist with extra training in eyelid and tear-duct surgery) often performs this repair. Swelling and bruising are common afterward, and scars keep improving for 6 to 12 months.
Radiation is an option for some people who cannot have surgery. For the uncommon basal cell carcinoma that is too advanced for surgery or radiation, doctors may use pills that block the hedgehog growth pathway, such as vismodegib. After treatment, specialists typically recommend regular follow-up exams for at least 5 years.
