Eyelid Disorders
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Direct answer
The common eyelid disorders are inflammatory — stye (external hordeolum), internal hordeolum and chalazion — plus blepharitis, trichiasis and ptosis. A stye is an acute staphylococcal infection of a Zeis gland at the lash root and is painful; a chalazion is a chronic, painless, granulomatous inflammation of a meibomian gland. A recurrent chalazion in an adult over forty, or one with loss of lashes and lid thickening, must be biopsied to exclude sebaceous gland carcinoma.
What you must remember
- External hordeolum (stye): acute suppurative inflammation of the gland of Zeis, usually Staphylococcus aureus; tender localised swelling pointing at the lid margin; treated with warm compresses, lid hygiene, topical antibiotics and epilation of the affected lash to drain it.
- Internal hordeolum: the same acute infection of a meibomian gland, pointing through the tarsal conjunctiva; management parallels a stye.
- Chalazion: painless firm nodule away from the margin, from retained meibomian secretion and granulomatous reaction; treated by incision and curettage through a vertical tarsal incision on the conjunctival side; may occasionally be injected with steroids.
- Blepharitis: squamous (seborrhoeic) blepharitis causes scales and irritation with the lid margin intact, while ulcerative (staphylococcal) blepharitis destroys follicles, causes lash loss and misdirection, and can lead to trichiasis and lid deformity.
- Trichiasis: misdirected lashes arising from a normal lid margin, abrading the cornea; treated by epilation, electrolysis, cryotherapy or lid margin surgery.
- Ptosis: drooping of the upper lid; congenital cases are usually myogenic from poor levator development, while acquired causes are aponeurotic (senile), neurogenic (third nerve palsy, Horner syndrome), myogenic (myasthenia, muscular dystrophies) and mechanical (tumours, scarring); levator function and margin-reflex distance guide surgery — levator resection for good function and frontalis suspension for poor function.
- Tumours: basal cell carcinoma is the commonest eyelid malignancy, typically a pearly nodule with rolled edges on the lower lid; sebaceous gland carcinoma mimics recurrent chalazion and carries a worse prognosis.
Common confusion
The chalazion versus stye distinction is the perennial viva question: acute, tender, marginal and pointing towards the skin or conjunctiva means hordeolum; chronic, painless and deep in the tarsus means chalazion. Next, do not confuse trichiasis with entropion — in trichiasis the lid margin is in normal position but individual lashes are misdirected, while in entropion the whole margin rolls inwards. In ptosis, remember that third nerve palsy adds restricted ocular movements and a dilated pupil, Horner syndrome adds miosis, and myasthenia produces fatigable variability through the day, which is why a plain diagnosis of ptosis without these associations is incomplete.
Exam-focused takeaway
In theory, prepare chalazion, blepharitis and ptosis classification as separate short notes, since each is asked repeatedly; the chalazion clue about sebaceous carcinoma earns extra credit. In viva, expect the chalazion-stye comparison, the causes of acquired ptosis and the surgery selected by levator function. In the outpatient posting, evert the lid of every chalazion before surgery, observe an incision and curettage, and examine lid margins of every red eye for blepharitis, since it explains chronic irritation that drops and antibiotics do not settle.
Frequently asked questions
How do you distinguish a chalazion from a stye?
A stye is an acute, tender, staphylococcal infection of a Zeis gland pointing at the margin, while a chalazion is a chronic, painless granulomatous swelling of a meibomian gland lying within the tarsal plate.
Why is the chalazion incision made vertically on the conjunctival side?
Vertical incisions follow the direction of the meibomian ducts and avoid cutting across adjacent ducts, limiting further blockage and recurrence.
When should a chalazion raise suspicion of malignancy?
In an adult, with recurrence at the same site, lid thickening, loss of lashes or yellowish nodule, suspect sebaceous gland carcinoma and send the curettings for histopathology.
What are the types of blepharitis and which is more serious?
Squamous (seborrhoeic) blepharitis with dry scales is milder; ulcerative (staphylococcal) blepharitis destroys lash follicles and causes lash loss, trichiasis and deformity, and is the more serious.
How is congenital ptosis treated?
By levator resection when levator function is fair to good, and by frontalis sling suspension when function is poor; surgery also guards visual development in severe cases.
Which is the commonest malignant tumour of the eyelid?
Basal cell carcinoma, usually a painless pearly nodule with rolled margins and central ulceration on the lower lid, treated by surgical excision with histological clearance.