Asymptomatic flat or slightly raised, yellow to yellow–orange plaques appear on the eyelids, particularly on the nasal side (Fig. 57-1). Small at first, the lesions slowly enlarge, and in some cases progress to involve virtually the entire lid. Most patients with xanthelasma are middle-aged or older. Xanthelasma in patients younger than 30 years is usually a sign of significant disturbances in lipoprotein metabolism. In approximately 60% of patients, xanthelasma is a normolipoproteinemic xanthoma with no demonstrable systemic cause. Nevertheless, these lesions may be associated with hyperlipoproteinemias that can result in atherosclerotic cardiovascular disease.