A 70-year-old woman has bilateral, symmetric, yellowish plaques on the medial aspects of the upper eyelids. Serum lipid profile is normal. What is the diagnosis and significance of this finding?
- A Eruptive xanthoma; indicates severe hypertriglyceridemia
- B Necrobiotic xanthogranuloma; always associated with paraproteinemia
- C Xanthelasma palpebrarum; no lipid abnormality is present in nearly half of cases ✓
- D Tuberous xanthoma; indicates familial hypercholesterolemia
Correct answer: C. Xanthelasma palpebrarum; no lipid abnormality is present in nearly half of cases
Explanation
Xanthelasma palpebrarum presents as soft, yellowish plaques on the medial upper eyelids, most commonly in middle-aged women. Approximately half of patients have normal lipid levels. Necrobiotic xanthogranuloma is associated with paraproteinemia but presents as tender, indurated plaques with ulceration. Eruptive and tuberous xanthomas appear on extensor surfaces and pressure areas, not the medial canthus.
Reference: Kanski's Clinical Ophthalmology, 9th ed.
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