Regarding bulbar xanthelasma, all of the following are true, EXCEPT:

Xanthelasma are creamy-yellow plaque-like lesions which frequently involve the skin of upper and lower lids near the inner canthus. They are occasionally associated with hypercholesterolemia or diabetes but which may occur without any associated disease. Xanthelasma occurs more commonly in middle-aged women. It represents lipid deposits in histiocytes in the dermis of the lid. Recurrences are common after excision. Ref: Ophthalmology by A K Khurana, 4th edition, Page 359