Chalazion

  • Granuloma of meibomian glands (reactions to accumulation of lipid following duct blockage)
  • Initially a hard and inflamed lump in the lid, settles to leave a discrete lump, visible on lid eversion
  • Often settle with conservative treatment (warm compress, chloramphenicol ointment).
  • If large, persistent or disrupting vision – incise and curette under anaesthesia.
  • Recurrent chalazia may indicate blepharitis, rosacea or meibomian gland malignancy

Styes

  • Infections of a lash follicle (red, tender swelling of lid margin, may have a head of pus)
  • Treatment with warm compresses and chloramphenicol.

Marginal cysts

  • From sweat glands (cyst of Moll) or lipid-secreting glands (cyst of Zeiss)
  • Dome shaped and lack inflammation
  • Removal only indicated for cosmetic reasons

Papillomas

  • May be pedunculated and/or multilobar, viral origin
  • Remove if large, disfiguring or lack diagnostic certainty

Basal cell carcinoma

  • Most common lid malignancy, mainly lower lid (sun exposure)
  • Does not metastasise, may be life-threatening due to local infiltration (especially in region of medial canthus)
  • Pearly, smooth edge with necrotic core although, may also present as a diffuse indurated lesion.
  • Urgent referral and excision indicated, palliative radiotherapy may be used in periorbital disease.

Blep​haritis

  • Chronic condition with sore, gritty  eyes and sore eyelids
  • Chalazion and stye more common and recurrent.
  • Physical signs: inflamed lid margins, blocked meibomian glands and margin crusting
  • Conjunctiva may be inflamed, punctate corneal staining with fluorescin.
  • Treatment:
    • Keep lids clean (cotton bud, warm water, baby shampoo)
    • Treat infection (antibiotic cream on lid margins)
    • Tear replacement
    • Treat sebaceous gland dysfunction (consider oral tetracycline)
    • Acute ulcerative form – Staph. or herpes virus
    • Acute non-ulcerative form – allergic process

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