• Clinical science

Inflammation of the eyelids

Summary

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.

Hordeolum (stye)

  • Definition: common acute inflammation of the tear gland or eyelash follicles (Zeis or meibomian glands)
  • Etiology
  • 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.
  • Complications

References:[1][2]

Blepharitis (blepharitis squamosa)

  • Definition: Blepharitis is a common eyelid condition that presents as a chronic and/or recurrent scaly inflammation of the eyelid margins.
  • Etiology
  • 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
    • Eye irritation and visual abnormalities
      • Pain
      • Itchiness
      • Foreign body sensation, watering of the eye
      • Photophobia, blurred vision
  • Diagnostics: clinical diagnosis
  • Treatment
  • Complications

References:[3][4][1][5][6]

Chalazion (meibomian gland lipogranuloma)

  • Definition: focal granulomatous swelling of the sebaceous glands without necrosis, which is primarily caused by obstruction of the glands
  • Etiology
  • 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 sebaceous 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 (once a malignancy has been ruled out)
      • 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:[7][8][9][10][1]