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…

eye hordeolum stye chalazion
Photo: Bill McBain

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

Ophthalmology Befuddler 700

CLINICAL CASES

Ophthalmology Befuddler

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.