Lid Disease
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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

References

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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