Benign Eyelid Disease

Question 1

Define stye

Answer 1

Abscess at an eyelash follicle

Question 2

Types of stye

Answer 2

external (hordeolum externum): infection (usually staphylococcal) of the glands of Zeis (sebum producing) or glands of Moll (sweat glands).
internal (hordeolum internum): infection of the Meibomian glands. May leave a residual chalazion (Meibomian cyst)

Question 3

Symptoms and signs of stye

Answer 3

Painful, red hot lump on the eyelid
- Pus-filled
- Localised around an eyelash follicle
External: eyelid margin (upper or lower)
Internal: further away from the lid margin

Epiphora (excessive watering)

Question 4

Management for stye

Answer 4

Conservative:
- Advise they are self-limiting and rarely cause complications
- Warm compresses (5–10 minutes 2–4 times daily)
- Advise to avoid using eye makeup or contact lenses until the area has healed.
- Do not puncture the stye
- Analgesia
Painful external stye → pluck the eyelash from the infected follicle to facilitate drainage
- Second line: Incision and drainage of the stye using a fine sterile needle,
Associated conjunctivitis → topical antibiotics e.g. chloramphenicol

Question 5

Prognosis for stye

Answer 5

Symptoms resolve within 5-7 days once the stye has been ruptured or drained
Recurrence only common in underlying blepharitis

Question 6

Define chalazion

Answer 6

Retention cyst of the Meibomian gland, a sterile, inflammatory granuloma caused by the obstruction of a sebaceous gland.

Question 7

Aetiology and risk factors of chalazion

Answer 7

The meibomian glands (located in the tarsal plate) are a set of glands that run along the eyelid margin. They produce a lipid secretion which provides the lipid layer of the tear film.
Obstruction of the gland duct causes the gland to enlarge and to rupture, releasing the accumulated lipid contents into the surrounding eyelid soft tissue.

Chronic blepharitis.
Seborrhoeic dermatitis.
Rosacea.
Pregnancy.
Diabetes mellitus.
Elevated serum cholesterol.
Chronic hordeola (styes).

Question 8

Symptoms and signs of chalazion

Answer 8

Firm painless lump in the eyelid
- Upper eyelid
- Sited away from the lid margin
Non-tender swelling that points inwards

Question 9

Management for chalazion

Answer 9

Conservative:
- Advise they are self-limiting and rarely cause complications
- Warm compresses
→ 10-15 minutes up to 5 times a day
→ Gently massage in the direction of the eyelashes using clean fingers or cotton bud
- Advise to avoid using eye makeup or contact lenses until the area has healed.
- Do not puncture the stye
- Analgesia

Question 10

Prognosis for chalazion

Answer 10

The majority of cases resolve spontaneously
Recurrence is more common in people with risk factors

Question 11

Complications for stye and chalazion

Answer 11

Infective conjunctivitis
Periorbital/orbital cellulitis
Meibomian cyst (chalazion)

Question 12

Causes of ectropion and entropion

Answer 12

Entropion = eyelid inversion → corneal irritation
Ectropion = lower lid eversion → watering and exposure keratitis (associated w/ ageing, CN7 palsy)

Elderly
Blepharitis
Bell’s palsy
Trachoma
Eyelid trauma
Scarring following shingles or allergic dermatitis