An Eyelid Lump
aka Ophthalmology Befuddler 003
It’s Saturday night and a 28 year-old man presents to the emergency department with a lump on his eyelid. He says his fiance forced him to come, because they are getting married in 2 weeks and his future wife doesn’t want him looking like a goggle-eyed monster…
Questions
Q1. What is the likely diagnosis?
Answer and interpretation
Either a chalazion or a hordeolum (stye).
Q2. What is a hordeolum?
Answer and interpretation
A stye, which is an eyelid lump resulting from acute infection; usually Staphylococcus.
There are two types:
- external: an abscess of one of the glands of Zeis on the lid margin.
- internal: an abscess of a meibomian gland.
Q3. What is a chalazion?
Answer and interpretation
An area of focal inflammation within the eyelid tarsus secondary to obstruction of a meibomian gland. It is not an infective process and is sometimes called a meibonian gland cyst or lipogranuloma.
Check out RootAtlas to see the mother of all chalazions…
Q4. Describe the management of chalazions and styes — and how do they differ?
Answer and interpretation
They are generally clinically indistinguishable – both are acute or chronic eyelid lumps associated with tenderness and eyelid swelling. If it’s particularly hot and red it may be more likely to be a stye/ hordeloum.
They are managed in much the same way:
- Warm compresses (e.g. 10 min qid) are the mainstay of treatment. The lump usually resolves within a week or so.
- The Will’s Eye Manual suggests treating with topical antibiotics if there is blepharitis or a draining lesion, and if severe consider treating with oral antibiotics (e.g. doxycycline 100mg bd, has both antibacterial and anti-inflammatory actions).
- The Australian Therapeutic Guidelines suggests oral flucloxacillin (or cephalexin) for 5 days for internal hordeolums (styes).
- Lesions that do not resolve over a month or so should be reviewed by an ophthalmologist and may be incised and drained.
Q5. What potentially nasty conditions may be the cause of a chronic eyelid lump?
Answer and interpretation
Look for signs of inflammation, distortion and skin ulceration.
Don’t forget about these bad boys:
- basal cell carcinoma
- squamous cell carcinoma
- sebaceous gland carcinoma
- others such as malignant melanoma, lymphoma, sweat gland carcinoma, and metastases.
References
- Ehlers JP, Shah CP, Fenton GL, Hoskins EN. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease Lippincott Williams & Wilkins
- NSW Statewide Opthalmology Service. Eye Emergency Manual — An illustrated Guide. [Free PDF]
OPHTHALMOLOGY BEFUDDLER
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
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