- 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
- Infections of a lash follicle (red, tender swelling of lid margin, may have a head of pus)
- Treatment with warm compresses and chloramphenicol.
- From sweat glands (cyst of Moll) or lipid-secreting glands (cyst of Zeiss)
- Dome shaped and lack inflammation
- Removal only indicated for cosmetic reasons
- 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.
- 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.
- 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