Lids – Lumps and Bumps

There are three main types of lid inflammation or discomfort that patients are likely to attend practice with – styes (or hordeolum), chalazion, cellulitis or more rarely but important to note here basal cell carcinoma.

Hordeolum

Hordeolums can be split into either an external hordeolum (commonly referred to as a stye) which is an acute infection of the eyelash follicle or an internal hordeolum which is a bacterial infection of the meibomian glands and can be seen on inversion of lid.

Signs/Symptoms

  • Localized redness sometimes around a distinct “head” of a cyst or spot
  • Swollen lid
  • Tenderness around area of inflammation
  • History of blepharitis
  • Pain
  • Epiphoria

Causes

  • Bacterium staphylococcus commonly

Treatment

  • Hot compresses and lid massage with increased levels of lid hygiene- heated eyebags can be useful.
  • Removal of the infected eyelash if very localized
  • Control of the underlying blepharitis if present
  • May need referring for antibiotic ointment or drops (chloramphenicol)
  • Can resolve spontaneously.

Typical external hordeolum- note localized raised, swollen area but no swelling (oedema) of the rest of the eyelid. A chalazion may look similar but without the associated redness.

Chalazion

Also known as a meibomian cyst, these are blocked glands within the eyelids which once they are blocked form a lipogranuloma – a hard lump – and become swollen. They can normally be differentiated from hordeolum as they are not painful due to lack of infection.

Signs/Symptoms

  • Swollen raised area on lid
  • History of blepharitis
  • Rosacea / Seborrheic dermatitis
  • Recurrent
  • May occasionally effect vision by causing astigmatism- rare

Causes

  • More common in patients with inflammatory disease
  • Blockage of oil producing gland in lid

Treatment

  • Lid hygiene advice
  • Hot compresses/eyebags
  • Topical antibiotic ointment
  • Referral for Oral tetracycline to treat any coexistent meibomian gland dysfunction.
  • If recurrent then referral to ophthalmologist for treatment/further investigations

Cellulitis

There are two forms of these infections pre-orbital/ pre-septal or post orbital/post septal and a wide range of severity from mild to potentially life threatening. These infections tend to effect children under the age of ten.

Pre-orbital: the infection is limited to the skin of the eyelids and there is no infections under the lids or extending into the orbit. The eye is white, moves normally without discomfort, no proptosis, vision unaffected- however in young children there is a high risk of any infection spreading further into the orbit.

Signs/Symptoms

  • Possibly signs of minor trauma
  • Possibly raised temperature
  • Signs of blocked cyst
  • ptosis
  • Recent or present upper respiratory tract infection
  • Sudden onset of acutely swollen lids with associated tenderness
  • General malaise

Causes

  • Staphylococcus, Streptococcus infections

Treatment

  • Emergency referral is recommended to rule out post-orbital cellulitis.

Post orbital: this is a potentially life threating  infection of the orbit and its contents.

Signs/Symptoms

  • Red eye
  • Proptosis- eye is pushed forward
  • Restricted, painful eye movements
  • Reduced vision
  • Pupil abnormalities
  • Patient is unwell
  • Present or recent sinus infection

Causes

  • Staphylococcus, Streptococcus infections

Treatment

Emergency referral