The major risk factors for coronary heart disease include smoking, elevated blood pressure, and elevated serum cholesterol.¹ Risk reduction starts with identification of those at risk and then alteration of factors such as discontinuation of smoking, lowering of blood pressure, and reduction of serum cholesterol. Patients who should have blood cholesterol testing include those with family history of premature coronary heart disease or hyperlipidaemia, personal history of coronary heart disease, or clinical evidence of elevated lipids with features of xanthelasma, corneal arcus under age 50 years, and cutaneous xanthomas at any age.¹ Two of the latter clinical features are ophthalmic and detection relies on the ophthalmologist.

Xanthelasma appear as multiple yellow placoid lesions in the periocular skin and represent a concentration of lipocytes in the dermis.² There are numerous methods to manage the cosmetic appearance of xanthelasma, which typically involves surgical excision or laser ablation.³ We report a novel approach to management using oral cholesterol lowering medication and …