Chalazion & Styes
A chalazion is a very common eyelid condition and is seen in children as well as adults. It is a localized inflammation of the eyelid. Patients will notice a bump on the upper or lower eyelid that can become red, swollen and painful. Mucoid discharge can be noted especially in the mornings when waking which can blur the vision. If the chalazion becomes large, it can press on the eye and cause blurry vision by distorting the curve of the cornea.
A chalazion develops when an oil gland (meibomian gland) is obstructed. These glands are located in the back layer (tarsal plate) of the upper and lower eyelids. When the oils cannot drain into the tear film, they are released into the surrounding tarsal plate and soft tissues. This creates inflammation in the eyelid which the patient experiences as pain and redness of the skin. Chalazia are common in patients with rosacea and blepharitis.
Many people use the term stye and chalazion interchangeably. Technically, a stye is caused by an infected eyelash root at the eyelid’s edge or an infected oil gland on the back of the eyelid. A style (or hordeolum) is considered external if it begins as an infection in the hair follicle. The stye (or hordeolum) is termed internal if it is inside the eyelid and forms from an infected oil-producing gland.
Treatment for styes can involve plucking the infected eyelash. To treat both conditions, a warm wet compress should be placed over the affected eyelid for 10-15 minutes at a time, 3-5 times a day. This will help the oil gland open and drain. You may be asked to perform lid scrubs to wash up the lash line. If an infection is present, topical antibiotic ointments or drops can be prescribed. If the eyelid is extremely swollen and bacterial cellulitis (lid infection) is suspected, an antibiotic pill may be needed.
Most chalazia will resolve with conservative management in 4-6 weeks. If the inflammatory mass becomes chronic and cystlike, an office procedure can be performed to excise the back wall of the cyst and remove the inflammatory tissue. Steroids are also injected at that time to manage the inflammation and speed the resolution of the chalazion.
Xanthelasma are yellowish deposits seen just under the skin surface in the inner corners of the upper and lower eyelids. These cholesterol deposits are located in the superficial dermis and subdermal tissues. Occasionally, xanthelasma can become larger, modular and extend into the underlying orbicularis muscle. Xanthelasma has diagnosed most frequently in 40 – 50-year-olds. They usually occur in patients with normal serum cholesterol levels.
Treatment involves complete excision of the lesion and suture closure. Care must be taken to not remove too much skin which can result in the eyelids not closing well or the eyelids pulling away/rolling away from the eye.
Unfortunately, xanthelasma can recur. It is reported that 40% of patients with one excision/removal had a recurrence. If the xanthelasma return and repeat excision are required, a skin graft may be necessary if there is not sufficient tissue to close the wounds.
Eyelid cysts can be fluid filled or epithelial. Fluid-filled cysts are called apocrine hidrocystomas. They transilluminate meaning they glow as the internal fluid is highlighted with an external light source. These lesions can be translucent or bluish in color. Multiple cysts can be present. Treatment involves complete excision of the cyst to prevent a recurrence.
Solid cysts of the epidermis are called epidermal inclusion cysts. They form from either the base of a hair follicle or from a surface epithelial cell being trapped below the skin surface. The lesions are slow-growing, round, elevated and smooth. If a cyst ruptures, the surrounding tissues can become markedly inflamed and/or infected. Treatment involves complete excision of the lesion.