As eyelids are very visible to everyone, lesions occurring on the lids are usually detected early.Similarly, conditions such as as excessive watering from the eye (epiphora) can be quite troublesome, especially in winter and the flu season, and many people will seek help earlier rather than later because of the degree of annoyance it causes.One of the more common benign eyelid conditions encountered in general practice is a chalazion. This is a granulomatous inflammation of the Meibomian glands in the lids, and presents as a firm swelling in the upper or lower lid, usually non-tender, rounded, and well delineated. It is easily treated with warm compresses and antibiotic ointment.
Rarely it will affect vision, with patients most frequently describing it as annoying rather than anything else. Should it persist, referral to an ophthalmologist for incision and curettage should be considered.
Closely related to the chalazion (Figure 1) is a slightly more serious inflammatory condition: a stye. A stye is a painful, pus-filled cystic lesion occurring on the eyelid. There is a risk that a stye could proceed to preseptal cellulitis, which can lead to severe complications. In addition to the standard antibiotic eye drops and ointment, oral antibiotics may be warranted in this case.Another very important condition of the eyelid that should not be missed is preseptal and orbital cellulitis. (Figure 2) These conditions are considered ocular emergencies as there is a high risk of the infection and inflammation spreading to the orbital tissues and the brain.
The condition can be recognised by diffuse swelling of the eyelids, with associated pain on touching the eye and painful or reduced eye muscle movements. Once the conjunctiva and eye movements are affected, or involvement of the pupil occurs, suspicion should be high for orbital cellulitis.Orbital cellulitis may or may not be preceded by dacryoadenitis, which is inflammation of the lacrimal gland. Dacryoadenitis is often very painful, with a very tender lump palpable in the lateral upper lid. Most patients will object to letting you touch it.Immediate referral to an ophthalmologist is necessary for hospital admission and intravenous antibiotics.
The condition can be recognised by diffuse swelling of the eyelids, with associated pain on touching the eye and painful or reduced eye muscle movements. Once the conjunctiva and eye movements are affected, or involvement of the pupil occurs, suspicion should be high for orbital cellulitis.Orbital cellulitis may or may not be preceded by dacryoadenitis, which is inflammation of the lacrimal gland. Dacryoadenitis is often very painful, with a very tender lump palpable in the lateral upper lid. Most patients will object to letting you touch it.Immediate referral to an ophthalmologist is necessary for hospital admission and intravenous antibiotics.