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Describe chalazion and hordeolum with their management.

Ophthalmology · 3rd Professional

Chalazion

A chalazion (meibomian cyst, tarsal cyst) is a chronic, sterile, lipogranulomatous inflammation resulting from obstruction of a meibomian gland, with retained sebaceous secretion provoking a granulomatous reaction in the surrounding tarsus.

It is not an infection, and that single fact governs the treatment: antibiotics do not resolve an established chalazion, and prescribing them repeatedly is the commonest error
Presentation — a painless, firm, rounded nodule within the lid, away from the margin.
It may point anteriorly through the skin or posteriorly through the conjunctiva, where it forms a granuloma that may rupture and discharge

Hordeolum

Feature	External hordeolum (stye)	Internal hordeolum
Gland involved	Gland of ZEIS or MOLL, associated with a lash follicle	Meibomian gland within the tarsus
Organism	staphylococcus aureus	Staphylococcus aureus, often in an infected chalazion
Position	AT the lid margin, pointing anteriorly through the skin, and centred on a lash	Deeper within the lid, pointing posteriorly through the conjunctiva
Pain	Acutely tender	More painful, because the pus is confined within the rigid tarsal plate
Treatment	Warm compresses; epilation of the associated lash.	Warm compresses and topical antibiotic; incision and drainage from the conjunctival surface if it does not settle; oral antibiotic if there is surrounding cellulitis
Outcome	Discharges and resolves in days	May resolve into a chalazion

Recurrent styes should prompt treatment of the underlying blepharitis, and testing for diabetes and for refractive error
Never squeeze a stye in the "danger area" of the face; the angular vein communicates with the cavernous sinus through the ophthalmic veins, and these veins are valveless, so infection can spread intracranially to cause cavernous sinus thrombosis
Distinguish both from preseptal cellulitis.
Antibiotics do not resolve an established chalazion, since it is a sterile lipogranuloma rather than an infection
Evert the lid to see it properly; a chalazion is best appreciated from the conjunctival surface and is easily under-assessed from outside
Incise vertically on the conjunctiva to damage the fewest adjacent glands, and horizontally on skin to follow the creases
Intralesional steroid suits a lesion near the punctum, where surgery would risk the canaliculus
Warn about depigmentation with intralesional steroid, which is far more visible in dark skin and matters to Indian patients
A large chalazion in a child induces astigmatism and can cause amblyopia.

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