Definition: Localized suppurative inflammation of hair follicle and its associated gland of zeis at lid margin.

 Usually caused by staphylococcus aureus  There is infection of hair follicle of eyelash.  It may complicate Acne Vulgaris in young adults.

Purulent infection of follicle and its gland with cellulites of surrounding connective tissue

 Stye are frequently recurrent, appearing in crops.  Recurrent lesion is particularly seen in cases of debility, focal infections and diabetics.

 Severe pain which is sharp throbbing, feeling of fullness or heaviness and feeling of heat  Tenderness (increase in pain on touching swelling/ affected area)  Pain subsides on escape of pus

 Starts usually as edema of the lids with chemosis  Yellow pus point appears on the lid margin around the root of a lash at the most prominent part of the swelling

 Skin gives way and pus drains with sloughing  Swelling subsides and cicatrix form  Spread of infection to neighbouring lashes opposite lid margin and conjunctival sac  Subsidence of inflammation may leave area of induration

 Cellulitis (particularly in cases of lesion at inner canthus)  Orbital thrombophebitis (leading to cavernous sinus thrombosis and its complications)

1.Systemic a. Antibiotic b. Anti-inflammatory analgesic c. Treatment of associated systemic predisposing cause

2. Local a. Hot fomentation b. Local broad spectrum antibiotic drop and ointment c. Evacuation of pus when pus points, sometimes epilation may be required before evacuation of pus (lid margin/ lesion should never be squeezed)

 Hordeolum Internum is a suppurative inflammation of meibomian gland.  It may be due to secondary infection of meibomian gland or it may start to begin with as suppurative infection of meibomian gland.  This condition is more symptomatic than stye, the gland is larger and is located in fibrous tarsal plate

 Pain, which may be severe throbbing  Swelling, which is away from lid margin  Pus pointing either at the lid margin or on the palpabral conjunctiva

 Swelling of affected lid, due to associated cellulitis  Swelling is more marked about 4-5 mm from lid margin  Tenderness  Palpabral conjunctiva over the swelling is congested a pus point may be visible  Pus point may be visible at the lid margin

 Medical treatment is similar to treatment of Hordeoulm externum i.e. Systemic a. Antibiotic b. Anti-inflammatory analgesic Local a. Hot fomentation b. Local broad spectrum antibiotic drop and ointment

 It may resolve with evacuation of pus at the lid margin  It may burst on palpabral conjunctiva, leading to infective bacterial conjunctivitis and persistence of growth on palpabral conjunctiva, resembling papilloma. It is due to fungating mass of granulation tissue sprouting through opening. It causes irritation and conjunctival discharge  It turns into chronic granuloma i.e. Chalazion

 Chalazion is also called tarsal cyst or meibomian cyst  Chalazion is chronic inflammatory granuloma of meibomian gland  Seen in adults more often as multiple lesions occurring in crops  The glandular tissue is replaced by granulation tissue consisting of gaint cells, polymorphonuclear cell, plasma cells and histiocytes, indicating reaction to chronic irritation. The opening of meibomian gland is occluded leading to retention which acts as cause of chronic irritation

Symptoms: Hard painless swelling little away from lid margin Swelling increases gradually in size without pain Small chalazia are better felt than seen Multiple lesions and large chalazion may be associated with inability to open eye fully

 Signs: Painless swelling 4-5 mm away from lid margin. Swelling is hard On conjunctival side it appears red or purple. In long standing lesions it appears grey. In old lesion granulation tissue turns into jelly-like mass. Chalazion may become smaller over the period of time, but complete resolution may occur only rarely Sometimes the granulation tissue is formed in the duct and project at the intermarginal strip as a reddish grey nodule

 Intralesional injection of Triamcinolone Acetonide may help in resolution of chalazion  Incision & curette of chalazion is indicated in cases when it causes disfigurement and mechanical ptosis due to its weight

 Explain about condition and operation  Informed consent  Topical anaesthesia and sub-muscular infiltration of 2% Lignocaine  Application of chalazion clamp around the nodule (this will provide field for bloodless operation, hard base and protect deeper soft structures). Lid is everted  Infiltration of lignocaine around swelling

 Vertical incision on most prominent point/ point of greatest discolouration with sharp scalpel blade  Semi-fluid/ cheesy contents are taken out with small chalazion scoop (Curette)  Pseudocapsule/ cavity is excised or the cavity is cauterized with pure carbolic acid or 10-20% trichloracetic acid

 Clamp is removed, and pressure is applied on lid to stop bleeding or pressure bandage is applied for few hours  Swelling remains for few days after surgery as the cavity is filled by blood  Post-operatively analgesic may be needed systemically. Local antibiotic drop and ointment for one to two weeks

 Very hard chalazion near canthi may be adenoma of gland and requires excision  Recurrent lesion particularly in elderly patients should be investigated for meibomian gland carcinoma (by biopsy)

 A small retention cyst of Apocrine Sweat Gland at lid margin.  It appears as small, rounded, translucent fluid filled non tender mass at lid margin

 It is a small non translucent retention cyst of sebaceous gland associated with hair follicle.  It is round non tender yellowish colored mass at lid margin.

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