Abstract
Case study
A 70-year-old patient presents with a firm, painless, localised eyelid swelling on the left eye that has slowly developed over the last few weeks. The swelling is around 6 mm in diameter.
Dr P. Marazzi/Science Photo Library.
This is meibomian cyst (Chalazion)
A chalazion is an inflammatory granuloma of the meibomian glands in the eyelid, which contain sebum. Meibomian glands span the eyelid margin and produce lipids, which coat the tear film. Blockage of the glands can result in growth and rupture of these small structures, which leads to the release of sebum into the adjacent tissue. This manifests clinically as a chalazion (National Institute for Health and Care Excellence (NICE), 2019).
The risk factors for progression of a chalazion include rosacea, pregnancy, diabetes mellitus, seborrheic dermatitis, chronic blepharitis, elevated serum cholesterol and hordeolum (BMJ Best Practice, 2018; Carlisle and Digiovanni, 2015).
A chalazion presents as a painless, firm, nodular 2–8 mm swelling, more common on the upper lid, away from the lid margin. Presentation can be unilateral or bilateral and vision is not usually affected unless the cyst is large and centrally placed (BMJ Best Practice, 2018; Carlisle and Digiovanni, 2015).
Complications of chalazion depend upon the size of the cyst. Larger cysts may be responsible for astigmatism through pressure on the globe. In rare cases, the cyst may become infected and spread to neighbouring soft tissue, becoming warm, tender and erythematous, causing periorbital or orbital cellulitis (Dubey et al., 2011).
Differential diagnoses include:
Blepharitis: Gritty sensation of eyelids with erythema of the lid margins and photophobia Dacryocystitis: Inflammation of the lacrimal sac, with a tender red swelling located below the medial canthus; the patient may present with decreased visual acuity owing to excessive tear production. Stye (Hordeolum): Presents as an acutely painful yellow pus-filled swelling on the eyelid margin or tarsal plate Malignant tumours of the eyelid:
Squamous cell carcinoma: Hyperkeratotic or ulcerating lesion Basal cell carcinoma: Pearly dome-shaped bump with surrounding teleangiectasia, may present with central ulceration
In primary care, a simple chalazion can be managed with a warm compress for 15 minutes, five times a day. After the application of the warm compress, eyelid massage will help to expel the contents of the cyst. Oral or topical antibiotics are not indicated as this is a sterile inflammatory process.
It is important to refer to an ophthalmologist if the patient develops visual disturbance or more profound inflammation. If there are recurrent meibomian cysts, it is advisable to refer to an ophthalmologist for incision and curettage (BMJ Best Practice, 2018; Carlisle and Digiovanni, 2015).
ORCID iD
Tasmeen Ahmed https://orcid.org/0000-0001-6995-2403