Inflammation of the eyelids

The eyelids contain various glands (meibomian, Zeis, and Moll glands), the secretions of which serve as components of the tear film and aid in the lubrication of the eyelids. Bacterial infections or accumulation/dysregulation of secretions can result in three common inflammatory conditions of the eyelid: hordeolum (stye), blepharitis, and chalazion. A hordeolum is an acute eyelid inflammation (usually infectious) associated with painful, erythematous, and pus-filled nodules. Blepharitis is a chronic (usually infectious) inflammatory condition associated with crusty, scaly plaques, and/or oily deposits on the margins of the eyelids. A chalazion is a focal sterile granulomatous swelling of the eyelid's sebaceous gland and may result from either a hordeolum or blepharitis. Diagnosis is usually clinical. Treatment depends on the particular condition and includes eyelid hygiene, topical antibiotics if an infectious etiology is suspected, or surgery.

• Definition: common acute inflammation of the tear gland or eyelash follicles (Zeis or meibomian glands)
• Etiology
  • Mainly Staphylococcus aureus, rarely Streptococcus
  • Increased occurrence in individuals with acne vulgaris and diabetes mellitus
• Classification
  • External hordeolum: : inflammation of Moll's or the Zeis gland at the lid margin
  • Internal hordeolum: inflammation of the meibomian gland; usually visible at the palpebral conjunctiva (less common)
• Clinical features
  • Painful, erythematous, tender pus-filled nodule
  • Spontaneous perforation and purulent discharge after a few days
• Diagnostics: usually a clinical diagnosis
• Treatment: Most styes are self-limiting and resolve spontaneously after 1–2 weeks.
  • Warm compress and massage
  • Eyelid margin hygiene
  • Topical antibiotic treatment, e.g., gentamicin, amoxicillin, erythromycin
  • In the case of non-response to medical therapy or severe symptoms: incision and curettage, with systemic antibiotics (e.g., cephalexin)
• Complications
  • May present as a chalazion over a few months
  • Abscess of the eyelid and orbital cellulitis are rare.

References:^[1][2]

• Definition: Blepharitis is a common eyelid condition that presents as a chronic and/or recurrent inflammation with scaling of the eyelid margins.
• Etiology
  • Staphylococci (most common causative pathogen)
  • Other infective etiologies: viral (e.g., herpes simplex or varicella zoster) or parasitic (demodicosis or phthiriasis palpebrarum). ^[3]
  • Allergic reactions or anatomical obstruction of sebaceous glands
    • Endogenous factors: oily deposits, seborrhea, hypersecretion of the eyelid glands, accumulation of secretion from the meibomian glands
    • External factors: smoke, dust, dry indoor climate, chemicals, drug toxicity
    • Systemic diseases: rosacea, atopy, and seborrheic dermatitis
    • Ocular diseases: dry eye syndromes (e.g., Sjögren syndrome), chalazion, trichiasis, conjunctivitis, and keratitis
• Classification
  • Anterior blepharitis: inflammation of the anterior margin of the eyelids, involving the skin, eyelashes, and follicles
  • Posterior blepharitis: inflammation of the posterior margin of the eyelids; associated with meibomian gland dysfunction and/or obstruction (meibomitis) as well as abnormalities of the tarsal plate
• Clinical features
  • Chronic or recurrent red, swollen eyelids and irregular eyelid margins
  • Crusty, scaly plaques, and/or oily deposits on the eyelid margin and eyelashes
    • Crusting usually represents seborrheic disease.
    • A ringlike collection around the eyelashes (collarette) with ulceration upon removal (ulcerative blepharitis) is typical of staphylococcal disease.
    • A smooth tubular collection at the base of the eyelash is typical of Demodex.
  • Eye irritation and visual abnormalities
    • Pain
    • Itchiness
    • Foreign body sensation, watering of the eye
    • Photophobia, blurred vision
• Diagnostics: clinical diagnosis
• Treatment
  • Eyelid margin hygiene
  • Topical antibiotics, in severe disease
• Complications
  • Chalazion
  • Conjunctivitis
  • Ectropion
  • Entropion
  • Trichiasis (abnormally directed lashes)

References:^{[1][3][4][5][6]}

• Definition: focal granulomatous swelling of the sebaceous glands without necrosis, which is primarily caused by obstruction of the glands
• Etiology
  • Poor eyelid hygiene, stress , or immunodeficiency
  • Systemic conditions: tuberculosis, rosacea, seborrheic dermatitis
  • Local anatomical abnormalities: complications of chronic blepharitis, malignancy, eyelid trauma, or post surgery
• Clinical features
  • Chronic (slow-growing), firm, rubbery nodule on the eyelid
  • Heaviness of the eyelid
  • Can cause visual disturbances, if large enough
• Diagnostics
  • Usually a clinical diagnosis
  • Everting the eyelid may allow for better visualization of the lesion.
  • Biopsy: for a persistent or recurrent chalazion (may indicate an underlying carcinoma of the eyelid)
• Treatment
  • Conservative: wait and watch , warm compresses , and eyelid hygiene
  • In secondary infection: local antibiotics, e.g., tetracycline, doxycycline, minocycline, or metronidazole
  • In case of persistent chalazia
    • Incision and curettage
    • Intralesional steroids

Persistent or recurrent chalazion may be a sign of a sebaceous carcinoma (a carcinoma of the meibomian gland). Chalazion may also clinically resemble a basal cell carcinoma!

References:^{[1][7][8][9][10]}