Midterm 2- Hordeolum/ chalazian cysts Flashcards
External hordeolum
Infection of a Zeiss gland
Internal hordeolum
Infection of a meibomian gland
main cause of hordeolum
Staphylococcus aureus is the infectious agent in 90-95% of cases of hordeolum
Abscess (“Bag of pus”) -
Hordeolum subjective
- Patients usually complain of a localized painful swelling on one eyelid
- In some cases, the complaint may start as a generalized edema and erythema of the lid that later becomes localized.
- A history of similar problems is common.
- Constitutional signs and symptoms are inconsistent with a hordeolum diagnosis
Hordeolum
Epidemiology:
-Found more frequently in persons who have
Diabetes
Other debilitating illness
Chronic blepharitis
Seborrhea
-High serum lipids (High lipid levels increase the blockage rate of sebaceous glands, but lowering of serum lipid levels in these patients has not decreased frequency of recurrence.)
External Hordeolum
Localized, raised, red bump near lid margin
Tender to touch
“Points” to skin side of lid
Hordeolum associated with
Hordeolum associated with staphylococcal blepharitis
external Hordeolum tx
- No treatment; usually are self-limited
- -Most eventually point and drain by themselves
- -Discharge anteriorly, close to the lashes
Warm soaks (qid for 15 min) are the mainstays of treatment
- Topical antibiotics may be used for recurrent lesions and for those that are actively draining
- Epilation of eyelash associated with infected follicle
- -May enhance drainage of pus
Internal Hordeolum
Localized, red, raised bump
Tender to the touch
Points to the conjunctival side of the lid
internal Hordeolum
infections
- Large internal hordeolum discharging anteriorly through skin
- Infection can spread from the gland to the lid connective tissue preseptal cellulitis
Hordeolum tx
- Usually are self-limited
- Most eventually point and drain by themselves.
- Warm soaks (qid for 15 min) are the mainstays of treatment.
- Topical antibiotics may be used for recurrent lesions and for those that are actively draining
- Surgical drainage of pointed lesions can speed the healing process
- Systemic antibiotics are indicated only when inflammation has spread beyond the immediate area of the hordeolum
internal
Drainage of a hordeolum
- Stab incision at the site of pointing using an 18-gauge needle or a #11 blade
- External incisions lead to scarring, so making external eyelid incisions or punctures is inadvisable, unless the hordeolum already is pointing externally
- A large abscess may have multiple pockets and require multiple stabs.
- Internal incisions should be made vertically to minimize the area of cornea swept by a scar during blinking
- Leave the incision open with a clean margin
Chalazion
- AKA meibomian cyst
- Lipogranulomatous infiltration of meibomian gland
- May follow an internal hordeolum
chalazion Signs
- Firm nodule within tarsal plate
- Non-tender, non-inflamed
- Some refer to a internal hordeolum as an acute chalazion
Chalazion tx
Warm compresses
10-15 minutes
At least qid but q2h better
Work best if lesion is recent
Steroid injection into lesion
0.1-0.2 ml triamcinolone injected through conjunctiva
Incision and curettage Local anesthetic Chalazion clamp Incision from conjunctival side Curettage - scrape out material Topical antibiotic ointment - X 2 days
Cyst of Moll
AKA suderiferous cyst or apocrine hidrocystoma
Arises from a blocked sweat-secreting gland associated with the cilia (gland of Moll)
Cyst of Moll features
Dome shaped Non-tender No inflammation Translucent Fluid-filled Anterior lid margin
Poliasis-
white lash
Cyst of Moll tx
- Primarily a cosmetic concern
- Can aspirate with a fine needle but recurrence is common
- Excision with removal of the sac to avoid recurrence
Cyst of Zeiss
- Arises from a blocked oil-secreting gland associated with the cilia (gland of Zeiss)
- Contains oily secretions and is less translucent than a cyst of Moll
Sebaceous Cyst
- Forms when an oil gland in the skin is blocked
- Can be found on any part of the body
- Yellowish-white lumps on the skin
- -Have a central punctum
- If squeezed, exude a stringy, cheesy white material
Sebaceous Cyst tx
- Primarily a cosmetic problem
- The total sac of the cyst must be removed
- If the cheesy material is just squeezed out, the cyst will reform
- In the case of an infected cyst, an oral antibiotic should be prescribed
Sebaceous Cyst prevention
Good hygiene may prevent the formation of sebaceous cysts
Some individuals are predisposed to development of these cysts, so even careful hygiene does not prevent them
