Author:
ShariSchabowski
Kevin J.McGurk
Description
- Result from inflammatory processes involving the gland s of the eyelid along the lash line:
- Hordeolum - acute gland ular obstruction resulting in inflammation and abscess formation
- Chalazion - end result of inspissation of gland ular contents and chronic granulomatous inflammation
- Hordeolum:
- Develops owing to outflow obstruction in 1 or more of the gland s of the eyelid
- Obstructed gland s may become secondarily infected
- May progress to localized abscess formation or may be complicated by periorbital cellulitis
- Chalazion:
- Chronic granulomatous inflammation in the meibomian gland :
- Originates from inspissated secretions
- Blockage of the gland 's duct at the eyelid margin may result in release of the contents of the gland into the surrounding eyelid soft tissue
- A lipogranulomatous reaction ensues
- Occasionally, chalazia become secondarily infected
- May evolve from incompletely drained internal hordeolum
Etiology
Hordeolum:
- May become secondarily infected:
- Staphylococcus most common
- Predisposing conditions:
- Meibomian gland dysfunction
- Blepharitis
- Rosacea
- Previous hordeolum
Signs and Symptoms
- Hordeolum:
- Develops acutely when gland ular outflow is obstructed
- Red, tender, painful, swollen mass along the eyelid margin
- Typically solitary, rarely may be multiple
- May be recurrent
- Well-localized inflammation
- Presentation depends on which gland is affected:
- External hordeolum (stye):
- Originates from obstruction of the superficial sebaceous or sweat gland s whose ducts are located between the eye lashes
- Exquisitely tender small mass that typically points anteriorly
- Internal hordeolum:
- Originates from obstruction of the sebaceous gland s whose ducts are located on the inner aspect of the lid margin
- Painful small mass that is palpable through the eyelid
- May cause a foreign body sensation in the eye and visual disturbance
- Typically more inflamed, larger, and more painful
- May point internally or through skin
- Nonsystemic process
- May be complicated by:
- Conjunctivitis
- Periorbital cellulitis
- Chalazion:
- Firm, circumscribed, nontender, or minimally tender nodule:
- Noninflamed
- Symptoms most commonly owing to physical properties:
- Disrupts natural contour of eye
- Obstructs visual field/peripheral vision
- Pressure on globe
- Corneal desiccation or injury due to exposure
- Nonacute, nonemergent process, which requires no urgent or emergent intervention unless secondary corneal or significant globe pressure is present
History
Hordeolum - sudden, well localized, painful mass along the margin of eyelid:
Physical Exam
Focal, tender, inflammation of an external or internal gland of the eyelid:
- Minimal surrounding edema may be seen
- Abscess may point within lash line, from palpebral conjunctiva, or externally via skin of the lid
Essential Workup
- Complete ophthalmologic exam including slit lamp exam and corneal evaluation
- Evaluation for evidence of associated cellulitis and /or systemic findings
- Hordeolum:
- Identify the origin of the abscess
- Chalazion:
- Determine whether physical properties of chalazion result in corneal exposure and injury
Diagnostic Tests & Interpretation
Lab
Cultures of any drainage rarely aids in management
Differential Diagnosis
- Blepharitis
- Dacryocystitis
- Dacryoadenitis
- Pyogenic granuloma
- Sebaceous cell carcinoma
- Basal cell carcinoma
- Squamous cell carcinoma
ED Treatment/Procedures
- Hordeolum - relieve obstruction and prevent abscess formation
- Warm compresses for 15 min 4-6 times per day
- Gently massage the nodule to express obstructed material
- Rarely, in severe cases, incision and drainage of internal hordeolum may be necessary:
- Typically done by ophthalmologist
- If pointed toward the conjunctiva, vertical incision is made to avoid injury to the meibomian gland s and reduce corneal injury from inadvertent scarring
- External skin incision is very rarely indicated
- When necessary, horizontal incision is used
- Removing single involved eyelash may be helpful in rare more severe cases of external hordeolum
- Botox
- Chalazion - complaints typically reflect nonemergent aesthetic and cumbersome physical properties of the mass:
- May resolve spontaneously
- Often respond to conservative therapy with warm compresses applied several times daily for 4-6 wk
- Referral to ophthalmology for incision and curettage or steroid injection if inadequate response to conservative management
- Lubricating eye drops may provide symptomatic relief
Medication
Ophthalmologic moisturizing drops as needed for comfort
Disposition
Discharge Criteria
No indication for admission unless secondary complication is present (i.e., marked periorbital cellulitis with systemic symptoms)
Issues for Referral
- Urgent consultation with ophthalmologist should be considered if incision and drainage of internal hordeolum is deemed indicated
- Persistent chalazia not responding to conservative therapy referred to ophthalmologist for definitive treatment options
Follow-up Recommendations
- Follow-up with ophthalmology in 1-2 d to evaluate response to conservative management of hordeolum
- Symptoms of hordeolum should completely resolve in 1-2 wk
- Chalazia present for >2 mo more likely to require definitive management with ophthalmology
- AycinenaAR, AchironA, PaulM, et al. Incision and curettage versus steroid injection for the treatment of chalazia: A meta-analysis . Ophthalmic Plast Reconstr Surg. 2016;32(3):220-224.
- CarlisleRT, DigiovanniJ. Differential diagnosis of the swollen red eyelid . Am Fam Physician. 2015;92(2):106-112.
- LindsleyK, NicholsJJ, DickersinK. Non-surgical interventions for acute internal hordeolum . Cochrane Database Syst Rev. 2017;1:CD007742.
- WuAY, GervasioKA, GergoudisKN, et al. Conservative therapy for chalazia: Is it really effective?Acta Ophthalmol. 2018;96(4):e503-e509.
- Zvand asaraT, DiaperC. Tips for managing chalazion . InnovAiT. 2012;5:133-136.
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