Chalazion and Stye Flashcards
Glands of the eyelid?
- Zeis
- Moll
- Meibomian
What is a stye?
Aka Hordeolum
- A common, acute inflammation of one of the sweat and sebaceous glands around eyelash follicles
- It presents as a localized pustular swelling with erythema and tenderness along the margin.
- Generally self-limiting and benign
- Can result in considerable discomfort and functional impairment
Classification of hordeola?
- Internal hordeolum
- inflammation of the meibomian gland
- Swelling under the conjunctival side of the eyelid - External hordeolum
- surface of the eyelid.
- arise from glands in the eyelash follicle or lid margin
- Glands of Zeis or Moll
Epidemiology of hordeola?
- Stye is common among young adults with refractive errors and
- Every age and demographic is affected
- Incidence is high in patients aged 30 to 50 years
> Higher incidences of meibomitis and rosacea
> Higher levels of androgens which increase viscosity of sebum - Affects both sex equally
Lifestyle Risk factors for hordeola?
- Age - 30 to 50 years old
- Poor eyelid hygiene
- Inadequate cleaning of the eyelid margins and touching eyes with unwashed hands promotes bacterial colonization and blockage of the sebaceous glands - Leave on eye makeup overnight
- Frequent use of makeup
- Blocks sebaceous glands, poor eye makeup removal practices encourages bacterial growth - stress which in turn weakens the immune system
- improper contact lens hygiene introduces bacteria to the eyelid margin
Local and systemic risk factors for hordeola?
- Chronic eyelid conditions
e.g. blepharitis and Meibomian gland dysfunction
- leads to obstruction of eyelids - Diabetes mellitus and rosacea
- Hyperlipidemia
- Seborrheic dermatitis
Pathophysiology of hordeola?
Pathogens?
an acute bacterial infection of the sebaceous glands of the eyelid
1. staphylococcus aureus
2. staphylococcus epidermidis
Pathophysiology of external vs internal hordeola?
- External hordeolum
- localized abscess formation in the follicle of the eyelash - Internal hordeolum
- Acute bacterial infection of the meibomian gland.
Signs and symptoms of hordeola?
- Localized painful swelling of one or more eyelids
- Generalised edema or hyperemia of the eyelid that later becomes localized
- Crust along the eyelid
- Discomfort during blinking
- Blurred vision
- Foreign body sensation
- Photophobia
- Tearing
Ddx of hordeola?
Infectious
1. Blepharitis
2. Preseptal cellulitis
3. Acute conjuctivitis
Benign lesions
4. Chalazion
Malignant lesions
5. Sebaceous gland carcinoma
6. Squamous cell carcinoma
7. Basal cell carcinoma
Investigations into stye?
Stye is a clinical diagnosis
Prevention of hordeola?
Daily good eyelid hygiene with mild soap and warm water
Management of hordeola?
Usually self limiting and can drain spontaneously
1. Conservative management
- Warm compress and lid massages
2. Antibiotics
- Erythromycin ointment can be applied to prevent spread of infection
3. Oral antibiotics such as doxycycline only when concern for periorbital cellulitis, bacteremia or tender preauricular lymph nodes
- use in the event of internal hordeolum
4. Incision and drainage
- For very large hordeolum
Note: Do not squeeze the stye
Complications of hordeola?
- Progression to chalazion that causes cornea irritation
- cosmetic deformity
- Eyelid cellulitis although rare
- If hordeolum is left untreated - Lid deformity
What is a chalazion?
aka Meibomian cysts
a focal lipogranulomatous swelling of one of the sebaceous glands around eyelash follicles
Chalaza appear on which eyelid most?
Affects upper eyelids more commonly than lower eyelids
- Because there are more meibomian (Sebaceous) glands in the upper eyelid
Epidemiology of chalaza?
- It is the most common inflammatory lesion of the eyelid
- Has no sexual predilection
- However, some studies report a higher incidence in females and they attributed that to hormonal influence on sebum production that happens during puberty and pregnancy.
- Common in a school going children and adulthood (30-50yrs)
- Very common but incidence is unknown
Lifestyle and local risk factors of chalaza?
- Age - 30-50years
Lifestyle factors - Poor eyelid hygiene
Local factors - Chronic blepharitis
- Prior chalazion
- Eyelid trauma / surgery
- Viral conjunctivitis
Systemic risk factors for chalaza?
- Seborrheic dermatitis / rosacea
- Tuberculosis
- ocular TB - Hyperlipidemia
- Malignancy
- Allergic responses
- Immunodeficiency
- Vit. A deficiency causing hyperkeratosis of the ducts resulting in blockage - Hormonal factors
- increased androgen induce the growth of sebaceous glands and sebum secretion
Pathophysiology of chalaza?
- Chalazion form when the oil produced in meibomian glands becomes too thick to be secreted or the opening of the oil gland becomes too narrow for the oil to drain easily
- The gland continues to secrete oil but has nowhere to drain so it causes enlargement of the gland and inflammation in the surrounding tissues leading to formation of lipogranuloma
Signs and symptoms of chalaza?
- Chronic (slow growing) firm ,painless rubbery nodule on the eyelid
- Chronic skin changes around the underlying nodule
- Heaviness of the eyelid
- Can cause visual disturbances
- blurry vision thus if the chalazion is large enough to compress the eyeball
Ddx of chalaza?
Benign lesions
1. Hordeolum
Infectious etiologies
2. Blepharitis
3. Dacrocystitis
Malignant lesions
4. Basal cell carcinoma
5. Sebaceous cell carcinoma
6. Squamous cell carcinoma
Other
7. nasolacrimal duct obstruction
Investigations into chalaza?
Clinical diagnosis.
1. Use history and physical examination
2. Test for visual acuity
3. For recurrent chalazia, a biopsy should be done to rule out malignancy.
Note: Key signs that point to malignancy include: telangiectasia, loss of eyelashes, irregular margins
Prevention of chalaza?
- Regular massage and warm compress
- Help in drainage of sebaceous secretion - Daily good eyelid hygiene
