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…

eyelid lump

Photo by McBill (click on image for link)

Questions

Q1. What is the likely diagnosis?

Either a chalazion or a hordeolum (stye).

Q2. What is a hordeolum?

A stye, which is an eyelid lump resulting from acute infection; usually Staphylococcus.

There are two types:

Q3. What is a chalazion?

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 this video at RootAtlas.com to see the mother of all chalazions…

Q4. Describe the management of chalazions and styes  — and how do they differ?

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.

Check out Mel Herbert’s EMRAP.TV summary of this condition and his own experience as a long suffering victim of this terrible affliction… He has some nice tips for using a spoon as a ‘warm compress’ device as well as some great clinical pics.

Q5. What potentially nasty conditions may be the cause of a chronic eyelid lump?

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, and Hoskins EN. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease (5th edition). Lippincott Williams & Wilkins, 2008.
  • Marx JA, Hockberger R, Walls RM. Rosen’s Emergency Medicine: Concepts and Clinical Practice, 7th edition (2009) Mosby, Inc. [mdconsult.com]
  • NSW Statewide Opthalmology Service. Eye Emergency Manual — An illustrated Guide, 2007. [link to free pdf]
  • Therapeutic Guidelines (Australia) [subscription required]
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Comments

  1. dymphnasis says

    This was informative, disgusting and awesome. Thanks for posting. As for the patient and his fiance I can’t believe they presented to the ED with this, Particularly with 2 weeks to go for the wedding. This is probably one of the best examples of ED abuse ever. Unless there were acute symptoms this could have been handled by an office visit to the primary MD or opthomologist. It is probably pretty obvious why health care is in trouble!

  2. says

    Thanks dymphnasis. The histories in the case-based Q and As are generally fictionalised accounts of real encounters. This particular one, I actually embellished to make it seem MORE urgent… Glad you enjoyed it.

  3. says

    the readers like myself is interested in reading the article in the form of questions and answers for easy understanding. keep writing in this form of Q AND A in your future articles also

Comments