Eyelid Problems

Question 1

What are the commonly encountered eyelid problems in primary care?

Answer 1

• Blepharitis: inflammation of the eyelid margins typically leading to a red eye
• Stye: infection of the glands of the eyelids
• Chalazion (Meibomian cyst)
• Entropion: in-turning of the eyelids
• Ectropion: out-turning of the eyelids

Question 2

What is the difference between a chalazion and a hordoleum?

Answer 2

A Hordoleum HURTS! is an infection. It is either:

• Internal - an infection of the Meibomian glands.
• External - an infection in the gland of Zeis

A chalazion - is a firm, nontender nodular non-painful inflammation on the inside of the eyelid, usually in the Meibomian gland.

Question 3

What are the 2 types of blepharitis and what are the most common causes of each?

Answer 3

• Posterior blepharitis (more common) due to Meibomian gland dysfunction
• Anterior blepharitis (less common) - seborrhoeic dermatitis/staphylococcal infection

Question 4

What is the treatment for blepharitis?

Answer 4

1. Softening of the lid margin using hot compresses twice a day
2. Mechanical removal of the debris from lid margins - cotton wool buds dipped in a mixture of cooled boiled water and baby shampoo is often used*
3. Artificial tears may be given for symptom relief in people with dry eyes or an abnormal tear film

Question 5

In what condition, is blepharitis more common/

Answer 5

Patients with Rosacea

Question 6

What are some features of blepharitis?

Answer 6

• Symptoms are usually bilateral
• Grittiness and discomfort, particularly around the eyelid margins
• Eyes may be sticky in the morning
• Eyelid margins may be red.
• Swollen eyelids may be seen in staphylococcal blepharitis
• Styes and chalazions are more common in patients with blepharitis
• Secondary conjunctivitis may occur

Question 7

What is the treatment for a hordoelum?

Answer 7

Hot compress and analgesia

(Only give topical antibiotics if there is associated conjunctivitis)

If not resolved after 4 weeks refer to opthalmology to consider I&D.

Question 8

What is the treatment for a chalazion?

Answer 8

Most cases resolve spontaneously.

Warm compresss applied for 15 minutes QDS.

If it has not resolved after 4 weeks refer to ophthalmology for I&D.

Question 10