Non Infectious inflammation of the eyelids

Question 1

Chalazion

-What is it and where is it located

Answer 1

Obstruction and inflammation (not active infection) of a meibomian gland with resultant lipogranuloma formation. White on surface of pseudo capsule

Anterotarsal- anterior to the tarsal plate (skin side)
Retrotarsal- Posterior to the tarsal plate (conj side, flip lid)

Question 2

Chalazion

Causes

Answer 2

Commonly due to chronic blepharitis, mid, ocular rosacea or inflammation within meibomian gland or gland of zeiss.

May have evolved from a previous hordeolum.

Question 3

Chalazion

Demographics and laterality

Answer 3

Demographics- no predilection. Maybe low socioeconomic, urban pop, women 10-30 and men 60+

Unilateral more likely

Question 4

Chalazion

Symptoms and signs

Answer 4

Symptoms- Bump on eyelid. Painless, mild tenderness. May have drainage.

Signs of anterotarsal: Visible or palpable nodule pointing anterior through skin.

Signs of retrotarsal: Visible or palpable nodule pointing posterior thru palpebral conj.

Question 5

Chalazion

Management

Answer 5

Warm compress with massage BID 10 mins.

Intralesional corticosteroid injection.
Rule of 6: Success rate is 60% for lesions less than 6 months and less than 6mm. Could do dermal or conj approach with needle. With dermal approach, could have sin depigmentation. Could take 1 year to resolve.

Incision and curettage under anesthesia.

Eyelid hygiene

Oral doxycycline if bleep

Question 6

If Chalazion recurs in same location, be suspicious of

Answer 6

Sebaceous gland carcinoma.

Question 7

Blepharochalasis

• What is it?
• Associated with what syndrome

Answer 7

Recurrent episodes of inflammatory edema of the eyelids.

Associated with Ascher syndrome- painless eyelid swelling, lip swelling and goiter.

Question 8

Blepharochalasis

Demographics and laterality

Answer 8

Typically teens-mid 20s. More common in women.

More common bilateral

Question 9

Blepharochalasis

Symptoms and signs

Answer 9

Symptoms- Painless eyelid swelling. Droopy eyelids with fine wrinkles.

Signs- Eyelid edema. Repeated episodes of edema may result in atrophy and laxity of the upper eyelid tissues. Thin, stretched, redundant skin with fine wrinkles due to on and off edema. Ptosis, deep superior sulci, and lacrimal gland prolapse.

Question 10

Blepharochalasis

Management

Answer 10

Self limiting within a few days but can recur. With time, episodes become less frequent.
No standard treatment protocol. Could do oral acetazolamide in conjunction with topical hydrocortisone or doxy.

If redundant skin, ptosis, or lacrimal gland prolapse, refer out for surgery.