Eyelid Abnormalities

Question 1

Three common types of eyelid abnormalities

Answer 1

Chalazion
Hordeolum
- External (stye) or Internal
Periorbital Cellulitis
- AKA Preseptal cellulitis)

Question 2

Define chalazion

Answer 2

A chalazion “hail stone” is a chronic inflammatory lesion that develops when a meibomian tear gland of the eyelid becomes obstructed.

Question 3

Chalazion Pathophysiology

Answer 3

Chalazia are caused by lipid inspissation in the meibomian glands, which ruptures and releases lipid from the gland into the surrounding tissues, causing a granulomatous inflammatory reaction.

In some cases chalazia can occur in the setting of an acute infection of a meibomian (internal hordeolum)

Question 4

Chalazion Increased Risk Groups

Answer 4

Rosacea (inflammatory, vascular and glandular changes involving the eyelids and ocular tissues)

Seborrheic dermatitis

Blepharitis (eyelid inflammation)

Question 5

Chalazion Clinical Presentation

Answer 5

First presents with eyelid swelling and erythema and then evolves to painless, rubbery, nodular lesion. Typically larger than styes.

Question 6

Chalazion Management

Answer 6

Conservative
- First line treatment with 46% of cases resolving themselves. Small chalazia often resolve over weeks. For larger lesions, frequent hot compresses may allow them to drain and clear within weeks to months.

Glucocorticoid injection
- Intralesional injections of triamcinolone clear chalazia in 75-84% of cases.

Incision and curettage
- The removal of pseudo capsule cosmetically debunks the tumour, while reducing the risk of re-accumulation in that gland.

Question 7

Chalazion Prognosis

Answer 7

Persistent or recurring chalazia should be checked histopathilogically for possible sebaceous cell, basal cell or meibomian gland carcinoma.
In the event of a meibomian abscess developing signs of periorbital cellulitis, systemic antibiotics against Staph aureus are given.

Question 8

Define Hordeolum

Answer 8

An acute inflammation of the sebaceous gland of the eyelid similar.

It can be an external hordeolum (stye) or internal hordeolum.

Question 9

Hordeolum Pathophysiology

Answer 9

Caused by a blockage in the small glands located along the eyelid margin. These glands produce oil and the blockage prevents normal drainage of the gland. If bacteria are trapped in the gland, an infection can develop, and the development of fluid and pus cause the area to become red and inflamed. In 90%-95% of cases, the resulting infection is caused by the bacteria called Staphylococcus aureus (sometimes known as “staph”). It is possible to have more than one hordeolum at a time, and it is common for them to reoccur.

Question 10

Hordeolum Clinical Presentation

Answer 10

Acute plugging of a sebaceous gland and associated inflammation results in a tender, erythematous bump.

Like a pimple on the eyelid

Question 11

Hordeolum Management

Answer 11

Conservative
- Most respond to warm compressions continued until the hordeolum points and spontaneously discharges. Topical antibiotics are usually not required. Removal of the eyelash involved is often helpful.

Question 12

Define Periorbital Cellulitis

Answer 12

Periorbital cellulitis (sometimes called preseptal cellulitis) is an infection of the anterior portion of the eyelid, not involving the orbit or other ocular structures.

Question 13

Pathophysiology or Periorbital Cellulitis

Answer 13

Strep or Staph infection of soft tissues secondary to abrasion, sinusitis, insect bites or foreign bodies.

Question 14

Periorbital Cellulitis Clinical Presentation

Answer 14

Eyelid swelling and erythema, without ophthalmoplegia, eye movements pain, chemosis or proptosis (all due to orbital cellulitis which is vision/life threatening)

Question 15

Periorbital Cellulitis Management

Answer 15

Broad-spectrum antibiotics against Staph and Strep

For children < 5 years old
- Augmentin or Cephalexin

For adults and older children
- Di/flucloxacillin