Dr Margaret answers e-mailers' embarrassing problems in this biweekly problem page.

Fatty lumps around the eyes

Dear Dr Margaret
I have white fatty spots under the inner corners of my eyes. Is there any way to get rid of them?

Some people have fatty-looking, slightly raised plaques in the skin near the eyes. They are either just below the eye or, more commonly, in the upper eyelid near the inner corner of the eye. The medical term for these is ‘xanthelasma’ (pronounced zan-th-laz-m). They usually appear gradually. They are not painful, tender or itchy. And they are not dangerous, because they do not turn into cancer and they do not affect the function of the eye or the eyelids.

They look fatty, because that is what they are. They are collections of cells called histiocytes, bulging with fat (usually cholesterol).

In some people xanthelasmas can be a sign that you have a raised level of harmful fats in the blood, such as a high cholesterol. This is important to know, because a high cholesterol level puts you at greater risk of having a heart attack (especially if you are also a smoker).Therefore the first thing you should do is visit your doctor for a blood test to check your cholesterol level, and the levels of the other fats in your blood. If your doctor discovers that your cholesterol is abnormal, you will be given advice about how to reduce it. For example, if you are overweight, you will need to fight the flab and eat more fruit and veg. You might also need to take cholesterol-lowering medication. If you manage to bring down your levels of cholesterol and other fats, you may find that the xanthelasmas slowly become less noticeable.

However, most people with xanthelasmas have completely normal cholesterol levels. In this situation, changing your diet will not improve the xanthelasmas.

The only sure way to get rid of them is to have them removed surgically. Obviously, this could be tricky in the delicate area near the eye, so it would have to be done by a plastic surgeon. In the UK, it is unlikely that this could be done under the NHS; you would probably have to pay for the operation to be done privately. If the xanthelasmas are really bothering you, this is a possible option, and your doctor could refer you to a suitable surgeon. However, in about 40% of people who have this operation, the xanthelasmas come back. This is most likely to happen in people who had them below and above both eyes, and who have an abnormal blood cholesterol.

Any more questions?
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