Caruncular Lesions

Caruncular Lesions | Jon Caster, MD | EyePlastics

The Caruncle & Its Lesions

The lacrimal caruncle is the small pink nodule you can see at the very inner corner of each eye. It is normal, healthy tissue — but like any tissue it can develop growths. Most caruncular lesions are benign, yet the caruncle’s location at the medial canthus, right beside the tear-drainage system, means lesions here deserve a knowledgeable eye and careful removal when needed.

This is an in-depth companion to our main Eyelid Skin Tumors & Lesions guide. Caruncular growths are part of the broader family of eyelid lesions, and sit beside the tear-drainage (lacrimal) system.

Caruncle Anatomy

The caruncle sits in the inner corner of the eye, medial to the semilunar fold of conjunctiva. It is a small mound of modified skin and conjunctiva that contains fine hairs, sebaceous (oil) glands, sweat glands, and accessory lacrimal tissue. Just lateral and below it lie the puncta — the tiny openings that begin the tear-drainage pathway — which is why surgery in this region is planned to protect tear outflow.

Common Caruncular Lesions

Papilloma — one of the most common caruncular growths (nevus is equally or more common); a soft, often frond-like benign lesion (see eyelid papilloma).
Nevus (mole) — a pigmented benign lesion that may darken slightly over time, especially around puberty or pregnancy.
Inclusion cyst — a fluid-filled benign cyst.
Oncocytoma and other glandular lesions — uncommon benign growths of the caruncle’s glands.
Malignant lesions — rare, but melanoma, sebaceous carcinoma, and other cancers can arise here, which is why atypical lesions are biopsied.

Warning Signs

Most caruncular lesions are harmless, but have one evaluated if you notice new or rapid growth, darkening or a change in color, surface irregularity or ulceration, bleeding, or a persistent feeling of fullness or irritation at the inner corner. Pigmented lesions that change are taken seriously because melanoma, although rare here, is possible.

Diagnosis

An oculoplastic surgeon examines the caruncle at the slit lamp, documents the lesion (often with photography to track change), and decides whether observation or biopsy is appropriate. Atypical, pigmented, or growing lesions are removed by excisional biopsy and sent for pathology to confirm the diagnosis.

Treatment

Benign, stable lesions can simply be monitored. When removal is warranted — for symptoms, appearance, or to confirm the diagnosis — excisional biopsy is performed under local anesthesia, with care to preserve the adjacent puncta and canaliculi of the tear-drainage system. Larger or malignant lesions may require wider excision and reconstruction.

When to See an Oculoplastic Surgeon

See a specialist for any caruncular lesion that is new, growing, pigmented and changing, bleeding, or irritating. Because the caruncle abuts the tear-drainage system, removal is best handled by a surgeon trained in eyelid and lacrimal anatomy.

See an oculoplastic surgeon

Eyelid lesions sit millimeters from the eye, where removal and reconstruction demand specialist care. Find an ASOPRS-trained oculoplastic surgeon near you.

Frequently Asked Questions

What is the caruncle of the eye?: The lacrimal caruncle is the small, pink, fleshy nodule at the inner corner (medial canthus) of the eye, where the upper and lower lids meet. It is normal tissue — a blend of skin and conjunctiva containing fine hairs, oil and sweat glands — and it is not part of the eyeball itself.
Are caruncle lesions usually cancerous?: No. The great majority of caruncular lesions are benign — most commonly papillomas, nevi (moles), and cysts. Malignant tumors of the caruncle are uncommon, but because they can occur, any pigmented, growing, or atypical caruncular lesion deserves evaluation and often a biopsy.
What does a normal caruncle look like vs. a lesion?: A normal caruncle is a small, soft, pink nodule that is symmetric with the other eye. Reasons to have a lesion checked include new growth, darkening or change in color, enlargement, bleeding, surface irregularity, or a feeling of fullness or irritation at the inner corner.
How are caruncular lesions removed?: Suspicious or symptomatic caruncular lesions are removed by excisional biopsy — the lesion is excised under local anesthesia and sent for pathology. The caruncle's location next to the tear-drainage system means an oculoplastic surgeon takes care to protect the puncta and canaliculi during removal.
Will removing a caruncle lesion affect my tearing?: Carefully performed excision of a caruncular lesion usually does not impair tearing. Because the tear-drainage openings sit just nearby, surgery is done with attention to those structures; significant or recurrent lesions may warrant evaluation of the lacrimal system.

Your Surgeon

Jon Caster, MD

🏅 ASOPRS Fellowship Trained

📞 936-560-5437