Pathophysiology

• Infection of Zeis, Moll, or meibomian glands by S. aureus
• External hordeolum: infection of Zeis/Moll glands, localized abscess at eyelash base
• Internal hordeolum: infection of meibomian glands, deeper in the eyelid
• Chalazia: mechanical obstruction of meibomian gland, painless nodule

Chalazion

• focal inflammatory lesion on the eyelid caused by obstruction/blocked duct of meibomian glands (sebaceous glands) at the margin of the eyelids
• Slowly enlarging
• Physical findings:
  • non-tender
  • non-fluctuant
  • non-erythematous nodule
• Usually less than 1 cm, more common on upper lid

Etiology

• Caused by inflammation and obstruction of sebaceous glands
• Lesion itself is inflammatory, not infectious

Management 

• warm compresses
• Lid massage and baby shampoo can be effective
• eyelid margin hygiene
• usually resolve within 1 month
• Antibiotics not routinely needed
• If >2 months – refer consider I+D non urgent
• Recurrent chalazia should be evaluated for malignancy

Complications

• Untreated chalazia can lead to preseptal cellulitis
• Large chalazia can cause visual disturbances and astigmatism
• Excision considered for lesions greater than 5 mm

Hordeolum 

• Acute bacterial infection of the eyelid margin
• Pustule with erythema, tender to palpation
• Involves upper or lower eyelid
• 90-95% caused by Staphylococcus aureus, followed by Staphylococcus epidermidis
• Differentiated from chalazion (less inflammatory, chronic)
• types
  • external hordeolum arises from obstruction and secondary infection of the sweat glands – glands of Zeiss or Moll. 
  • Internal hordeolum is an acute infection of a meibomian gland.
• Hordeola usually discharge spontaneously following management with warm compresses

Risk Factors

• Blepharitis
• Contact Lens wear
• Make-up or cosmetic application
• Poor Eyelid hygiene

Management 

• Warm compresses and erythromycin ophthalmic ointment recommended
• Apply compresses for 15 minutes, 4 times a day
• Gentle massage suggested
• Large hordeola may require ophthalmologist referral for incision and drainage
• Reevaluation in 2-3 days
• eTG: Topical antibiotics are not indicated for chalazia and hordeolum.
• Untreated stye may lead to localized cellulitis or periorbital cellulitis
• Monitor worsening erythema and edema closely
• Oral anti-staphylococcal antibiotic therapy is indicated if there is accompanying cellulitis.
• Blepharitis
  • inflammation of eyelid margin, not a discrete nodule
    • drug regimens for periorbital cellulitis)
      • Incision and drainage may be necessary for persistent lesions
      • Can have assoc pre-septal cellulitis may need oral Abx’