Lids

STYE (EXTERNAL HORDEOLUM) A stye is an acute staphylococcal infection of an oil gland associated with an eyelash. It is located at the lash line and has the appearance of a small pustule. It can be either ruptured or left alone. Warm compresses and erythromycin ophthalmic ointment bid for 7 to 10 days is usually sufficient treatment.

CHALAZION (INTERNAL HORDEOLUM) A chalazion is an acute or chronic inflammation of the eyelid secondary to blockage of one of the meibomian oil glands in the tarsal plate. A reddened, tender lump develops in the lid or at the lid margin. Initial conservative treatment consists of warm, moist compresses three or four times a day and erythromycin ophthalmic ointment applied to the eyelid margin qid. Some ophthalmologists will also add a 14- to 21-day course of doxycycline (tetracycline derivatives are secreted in the oil glands). The patient should follow up with an ophthalmologist in about 6 weeks or less if any worsening occurs. Chronic inflammation will induce a cystic wall, and a discrete lump develops that is usually both palpable and visible in the lid. Chalazions can cycle between being quiet or acutely inflamed. The patient with a chronic, recurrent chalazion should be referred to an ophthalmologist for surgical excision and curettage, which is the definitive procedure.

Treatment:

1. Warm moist compresses three to four times a day.

2. Erythromycin ophthalmic ointment applied to lid margins qid.

3. Consider doxycycline 100 mg PO bid for 14 to 21 days if chronic and recurrent.

4. Ophthalmology referral 4 to 6 weeks.

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