Summary
Common inflammatory conditions of the eyelid include blepharitis, hordeola (styes), chalazia, and eyelid dermatitis. Blepharitis is a chronic condition that manifests with redness, swelling, crusty scaling and/or oily deposits on the eyelid margins. It is typically caused by staphylococcal infection, seborrheic dermatitis, or meibomian gland dysfunction. A hordeolum is an acute inflammation of the meibomian glands (internal hordeolum) or the Moll or Zeis glands (external hordeolum). It manifests suddenly as a painful, erythematous, pus-filled nodule and is typically caused by acute staphylococcal infection. A chalazion is a focal noninfectious lipogranulomatous swelling of the Zeis or meibomian glands and manifests as a slow-growing, firm, painless, rubbery nodule; it can develop from either blepharitis or a hordeolum. Diagnosis of these conditions is clinical and includes ruling out other emergency causes of red eye. Initial management is conservative, comprising warm compresses and eyelid hygiene. If symptoms persist or recur, patients should be referred to ophthalmology for additional management, which may include antibiotics and/or procedural intervention such as incision and curettage. Management of eyelid dermatitis (e.g., contact dermatitis, atopic dermatitis, seborrheic dermatitis) is tailored to the specific condition.
Blepharitis
Definition [1]
- Blepharitis is a common eyelid condition that manifests as a chronic and/or recurrent inflammation with scaling of the eyelid margins.
- Classified according to location
- Anterior blepharitis: inflammation of the anterior margin of the eyelids, involving the skin, eyelashes, and follicles
- Posterior blepharitis: inflammation of the posterior margin of the eyelids; associated with meibomian gland dysfunction
Etiology [1][2]
-
Anterior blepharitis
- Staphylococci (most common causative pathogen) [1]
- Seborrheic dermatitis
-
Posterior blepharitis: meibomian gland dysfunction, e.g.:
- Anatomical obstruction
- Hypersecretion
- Other risk factors and associated conditions
- Other infective etiologies: viral (e.g., herpes simplex or varicella zoster) or parasitic (demodicosis or phthiriasis palpebrarum)
- Other dermatological diseases: rosacea, atopic dermatitis, psoriasis
- Allergic reactions and irritation from smoke, dust, dry indoor climate, chemicals, cosmetics, drug toxicity
- Other ocular diseases: dry eye syndromes (e.g., Sjogren syndrome), giant papillary conjunctivitis
Clinical features [1][3][4]
- Chronic or recurrent redness and swelling of the eyelid margins
-
Crusty scaling and/or oily deposits on the eyelid margin and eyelashes
- A ringlike collection around the eyelashes (collarette) is typical of staphylococcal disease.
- A smooth cylindrical collection at the base of the eyelash is typical of Demodex.
- Ulcerations can occur with severe staphylococcal disease (ulcerative blepharitis).
-
Eye irritation and visual abnormalities
- Pain
- Itchiness
- Foreign body sensation, watering of the eye
- Photophobia, blurred vision [5]
- Worsening of symptoms in the morning
Management [1][5]
- Diagnosis is clinical.
- Refer urgently to ophthalmology for any of the following:
- Suspected emergency cause of red eye (e.g., preseptal cellulitis)
- Vision impairment
- Moderate to severe pain
- Severe, chronic, or recurrent symptoms
-
Initial management: supportive therapy
- Warm eyelid compress for 15 minutes, 1–2 times daily [1][5]
- Eyelid cleansing with massage, 1–2 times daily [1]
- Artificial tears as needed for dry eyes (preservative-free formulation if using > 4 times per day) [1]
- Explain to patient that the condition is chronic and long-term supportive therapy is necessary.
- Refractory symptoms: Refer to ophthalmology.
Patients with advanced glaucoma should avoid applying significant pressure to the eyelids, as this may increase intraocular pressure. [1]
Complications [1][4]
Hordeolum and chalazion
Definition [4][7]
-
Hordeolum (stye)
- A common, acute inflammation of one of the sweat and sebaceous glands around eyelash follicles
- Classified according to location
- External hordeolum: inflammation of a Moll or Zeis gland on the anterior lid margin [8]
- Internal hordeolum: inflammation of a meibomian gland on the posterior eyelid (palpebral conjunctiva)
- Chalazion: a focal lipogranulomatous swelling of one of the sebaceous glands around eyelash follicles [9]
Etiology [10]
-
Primary causes
- Hordeolum: infection with Staphylococcus aureus
- Chalazion: obstruction of a sebaceous gland (Zeis or meibomian gland)
-
Risk factors: similar for both hordeolum and chalazion [8][11]
- Ocular: poor eyelid hygiene, chronic blepharitis, eyelid trauma, meibomian gland dysfunction
- Dermatologic: rosacea, seborrheic dermatitis
- Demodicosis
Clinical features [4][6][7]
| Clinical features of hordeola and chalazia [4][6][7] | ||
|---|---|---|
| Hordeola | Chalazia | |
| Onset |
|
|
| Appearance |
| |
| Other |
|
|
An internal hordeolum can progress to form a chalazion. [7]
Management [2][3][7]
- Diagnosis is clinical.
- Refer urgently to ophthalmology if an emergency cause of red eye (e.g., preseptal cellulitis) is suspected.
-
Conservative management: Hordeola typically resolve within 2 weeks; chalazia typically resolve in a month or more. [3][7]
- Gentle massage with a warm compress for 10–15 minutes, 3–5 times daily. [3][6]
- Regular eyelid hygiene
-
If symptoms persist or recur, refer to ophthalmology for additional management. This may include:
- Topical antibiotics (e.g., bacitracin, erythromycin) +/- topical corticosteroids
- Oral antibiotics (e.g., doxycycline)
- Procedural intervention, e.g.:
- Incision and drainage or curettage
- Intralesional steroid injection for a chalazion
- Biopsy [7]
Persistent or recurrent chalazion may be a sign of a meibomian gland carcinoma (a sebaceous carcinoma). Chalazion may also clinically resemble a basal cell carcinoma. [7]
Complications [6]
Eyelid dermatitis
Etiology [4][13]
- Allergic contact dermatitis (most common)
- Irritant contact dermatitis
- Atopic dermatitis
- Seborrheic dermatitis
Clinical features [4][13]
Management [4][13]
Details are addressed in the respective articles (see “Etiology”).
- Diagnosis is typically clinical.
- Perform a total-body skin examination.
- See “Irritant vs. allergic contact dermatitis.”
- Management is based on the underlying etiology.
- Instruct patients to avoid potential allergens and irritants, such as eye and facial cosmetics.
- For steroid treatment of allergic contact dermatitis and atopic dermatitis, use a low-potency steroid such as desonide . [4]
- If diagnosis is uncertain or symptoms persist, consider:
- Patch test to identify allergens
- Dermatology referral