Good Hope, Heartlands, and Solihull Eye Clinics

Eyelid lumps etc

David Kinshuck

 

Styes

diagram of stye

A stye is an infection in the edge of the eyelid. The infection is in a gland at the base of an eyelash, and is usually caused by staphylococcal bacteria. The treatment you need depends on how severe the infection is. See

 

 

 

 

A photograph of an early stye explanation

stye,the eyecentre.com

 

 

 

 

 

 

 

 

Treatment of styes

very mild infections Here here is a little redness and swelling This can be treated with hot bathing and cleaning of the eyelid.
  • ‘hot bathing’: bathe the stye with a compress, such as a flannel or tissue, soaked in warm water.
  • The water should be hot but not hot enough to burn, and the bathing is usually need 4 times a day for about 10 minutes, until the stye starts to go, usually 2 days.
  • Alternatively use hot spoon bathing: hold a spoon with a flannel wrapped round soaked in hot water beneath your eye so the steam rises.
average Styes that are more painful with more swelling also need antibiotics, such as chloramphenicol cream x4 a day, or fucithalmic x2 a day from your general practitioner. Take care not to spread the infection to the other eye.
severe Severe styes cause swelling of the entire eyelid (preseptal cellulitis) may need antibiotic tablets: your general practitioner will need to advise   See    If you are not allergic to penicillin, coamoxyclav is generally effective, and needs a precription from your GP.     

 

Meibomian Cysts (chalazions)

diagram of chalazion

See chalazion. Meibomian cysts (or ‘chalazions’) have different stages. If your eyelid has a small lump in, and is red, painful, and swollen, treat like a stye as above. Meibomian cyst is the name given to a lump in the eyelid; this lump may consist of debris remaining after an infection blocking the gland. Once the main infection has subsided, they do not grow bigger, and are then not very red or painful.

Nearly all the chalazia/lumps disappear naturally in about 8-16 weeks or a lttle longer. See

chalazion (present a long time)

a chalazion that has been present some time (best having minor surgery)

 

 

The only exceptions are the hard and firm chalazia, and if the lump does not disappear naturally, it can be removed by a small operation in the eye clinic (special funding is required from GPs surgery, and this is often not available). The doctor injects a little local anaesthetic into the eyelid to make it feel numb.

The cyst is then scrapped out. Sometimes the shell of the cyst is very thick, and the doctor may be able to scrape out the contents, but the shell cannot be removed. If this happens, a small lump may remain in the eyelid. Very occasionally a second operation may help. The operation may cause bruising of the eyelid. If it does, the bruising may take about a week to go. Usually a tiny cut is made on the inside of the eyelid, so there is no scar. If the lump is just under the skin, the doctor may make a tiny cut in the skin.

 

 

acute chalazion, eyemac.com

acute chalazion needing hot bathing and antibiotic cream (possibly tablets as well)

a healing chalazion
a recent acute chalazion: this is likely to settle without surgery

 

 

 

 

 

 

 

 

Preseptal Cellulitis adults

If not allergic to penicillin, adults :

  1. webmd.com/eye-health/periorbital-cellulitis     eyewiki.aao.org/Preseptal_cellulitis
  2. co-amoxyclav 325 mg 3 times a day 1 week
  3. alternative if penicillin allergy or flucloxacillin unsuitable: clarithromycin or erythromycin (in pregnancy).
  4. Hot bathing (not too hot to burn)
  5. occ chloramphenicol 4 times a day 1 week

 

Recurrent chalazions: prevention

If you develop chalazions quite frequently, preventative treatment may be helpful see. Chalazions may be caused by blockage and infection of the glands in the eyelids. Some people who develop frequent chalazions have dry skin, with secretions blocking the glands.

Treatment that unblocks the glands in the eyelid may help stop more chalazions developing. To prevent the glands blocking, (see blepharitis page):

Very brief

  1. Heat compresses and massage twice a day
  2. Blephaclean or blephasol twice a day
  3. Preservative free lubricant
  4. vitaPos night

More details

  • The cleaning helps to reduce the number of bacteria in the glands of the lid. This is the same treatment as for blepharitis and reduce all sorts of lid problems.
  • Gently clean with a cotton bud, looking in mirror

    Gently clean with Blepharaclean wipes ( or a cotton bud if unavailable), looking in mirror, pull the lower eyelid down with the index finger of one hand, and gently but firmly wipe the wipe or bud along the edge of the lid to scrape the debris off. With your chin up try the same on the upper lid, but this is harder.

  • Cleaning: clean lids with Blepharaclean wipes (these can be bought or obtained from a doctor's prescription, or if unavailable a cotton bud). Clean the edge of the eyelids (the eyelash edge) with the wipe or wet cotton bud. Gently scrape off the debris moving the wipe/bud side to side. If using a bud, warm tap water is usually quite safe. The Blepharaclean wipes are probably more effective.
  • Bathing: warm compresses with an 'Eyebag' hot compress: these can be bought or obtained on prescription, and one lasts a long time (or similar compress, there are may brands). If you don't have a compress or a microwave, use clean face cloth soaked in warm water, as hot as your eyelids can stand. Bath the eye (closed) for 5-10 minutes. Re-warm the cloth if it gets cold. This makes the debris easier to remove, as below.
  • massaging: gently pull the low lid down and (using a mirror) gently press on the lid margin moving fingers over the bone under the lid. (see text   YouTube video) WIth the upper lid this is much harder ..try to gently press on the upper lid. Repeat this over 30 seconds. Try to express he secretionsin the glands by massaging towards the edge of the lid.
  1. If the cleaning is not helpful preventing the chalazions, antibiotic ointment may help. Your GP will need to prescribe it; try it for 3 months (chloromycetin or fucithalmic).
  2. A healthy diet with omega 3 (or flaxseed oil) and plenty of vegetables and often very important.
  3. Sometimes chalazions return once the ointment is stopped, and you may need a repeat prescription from your GP. Some people benefit using the cream intermittently.
  4. Finally, if all else fails and you still develop more chalazions, a course of antibiotic tablets may help in adults who are not pregnant, such as doxycycline 50-100mg daily for three months (from your GP). The benefit of antibiotics lasts several months after stopping treatment, but if the condition returns you may need to use further courses. Erythromycin for 2 months or so helps children.

    This treatment is sometimes useful if the other treatments do not work. It is particularly effective if you have a skin condition, such as acne rosacea, or very dry skin, or if the edge of your eyelid stays red with many scales.
    Antibiotic tablets are NOT suitable for everyone, particularly if you use several other tablets or have stomach problems. You will need to discuss this treatment with your GP first. See excellent article for BMJ subscribers   BJO 2011

Cysts of moll

cyst of moll

These are tiny cysts with fluid inside. They do not grow. After a local anaesthetic injection, a small nick is made in the cyst. The skin of the cyst is also removed. Usually they do not recur.

 

Papillomas

eyelid papilloma

Papillomas can grow to different sizes. They are probably caused by a virus, and are essentially warts on the skin.

 

 

eyelid papilloma,eyeatlas.com

They are removed in a ‘minor operations’ clinic in the eye department. Your skin is anaesthetised with a small injection. The papilloma is then cauterised. Usually a little scab forms, and heals in a week, leaving a nearly invisible scar.

If the papilloma is near the edge of the eyelid, the scar may make the edge a little crooked. They may recur after the operation, which may need to be repeated.

 

 

Melanoma

   Lesions with any of the major or three of the minor are suspicious of melanoma BMJ:

 

major features
  • change in size
  • irregular shape
  • irregular colour
minor features
  • largest diameter =/> 7mm
  • inflammation
  • oozing
  • change in sensation

 Entropian

  • link
  • entopians of upper lid..? pemphigoid or trachoma
  • lower lid...? chronic conjunctivitisl
  • leaflet and taping

Ectropian 

  • lateral...eczema, sun, allergy
  • normally medial

Funding 

  • Chalazions... put on authorisation form 'conservative treatment has failed' ideally try for 6 months.
  • Any suspect cancers or recurrent chalazions which are effectively suspect cancers do not need authorisation, do write in notes surgery/ biopsy to exclude cancer to avoid refusal.

Sturge-Weber Syndrome