Related Subjects:
|Primary Biliary Cirrhosis
|Chronic liver disease
|Cirrhosis
|Alkaline phosphatase (ALP)
|Liver Function Tests
🟡 Xanthelasma (eyelid cholesterol plaques)
- Soft, yellowish, flat or slightly raised plaques on the medial upper/lower eyelids.
- Benign and often asymptomatic, but a visual cue to check lipids & cardiovascular risk.
- Spelling: xanthelasma (not “xanthelamas”).
🧭 Causes & Associations
- 📈 Hyperlipidaemia: ↑ LDL-C and/or ↑ triglycerides
- 🩺 Diabetes / metabolic syndrome
- 🦋 Hypothyroidism
- 💚 Primary Biliary Cholangitis (PBC) or other cholestatic liver disease
- 🧬 Familial dyslipidaemias (e.g., familial hypercholesterolaemia)
- 🧪 Occasionally idiopathic with normal lipids, especially with age
🧑⚕️ Assessment (primary care)
- History: onset, growth, prior lipid results, family history of early MI/stroke or tendon xanthomas, alcohol, diet, medications (e.g., retinoids, antiretrovirals)
- Examination: eyelid plaques; screen for tendon xanthomas, corneal arcus (<45 yrs), hepatomegaly, stigmata of cholestasis
- Investigations:
- Fasting/non-fasting lipid profile (TC, LDL-C, HDL-C, TG; consider non-HDL-C)
- HbA1c / fasting glucose; TSH; LFTs if cholestasis suspected
- Secondary causes: nephrotic syndrome, hypothyroidism, PBC
- Risk: calculate 10-year ASCVD risk (QRISK3 in UK) to guide statin therapy
🩹 Management
- 🎯 Treat underlying dyslipidaemia and cardiovascular risk (lifestyle + statin first-line; ezetimibe or PCSK9 inhibitors in specialist care if indicated)
- 🍏 Lifestyle: diet quality (↓ saturated fat, ↑ fibre/plant sterols), weight, exercise, limit alcohol (esp. if TG high), stop smoking
- 👁️ Cosmetic removal (if desired/symptomatic): cryotherapy, electrocautery, chemical cautery (TCA), laser (CO₂/Er:YAG), or surgical excision. Recurrence is common
- 🧴 Gentle peri-ocular skin care; warn about post-procedure pigment changes/scarring; refer to oculoplastics/derm if near lid margin
🚩 Refer / Specialist Advice
- Very high LDL-C, tendon xanthomas, strong family history → consider familial hypercholesterolaemia (lipid clinic)
- Features of cholestasis or abnormal LFTs → hepatology work-up (consider PBC)
- Cosmetic removal near canthus/lid margin → oculoplastics / dermatology
🗣️ Patient-friendly message
“These soft yellow eyelid patches are called xanthelasma. They’re harmless, but may signal higher cholesterol. We’ll check your lipids and overall heart risk, support you with treatment, and if the patches bother you, safe removal options exist—but they can recur, so treating cholesterol remains important.”
📚 Quick Reference / UK Primary Care
- High cholesterol • High triglycerides • Diabetes • Hypothyroidism • Primary Biliary Cholangitis
💡 NICE-aligned teaching point: Xanthelasma is often the first visible sign of underlying dyslipidaemia. Early identification allows cardiovascular risk assessment and intervention, while cosmetic concerns are secondary to systemic management.
