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General
i. Improvement of general health and personal hygiene should be done.
ii. Dandruff of the scalp is adequately treated.

STYE (HORDEOLUM)
Stye is an acute suppurative inflammation of one of the Zeis’s glands.

Etiology
1. It is usually due to presence of staphylococci infection occurring in crops. It is often associated
with boils, carbuncles and acne over face.
2. It is most common in young adults and debilitated persons.

Symptoms
There is acute pain and tenderness over the inflamed Zeis’s gland.

Signs
1. A localised painful and hard swelling is seen
near the lid margin.
2. The lid margin is red and oedematous.
3. An abscess (yellow discolouration) may form
which points near the base of the lash.
4. The pain subsides after evacuation of the pus.

Treatment
1. Hot fomentation applied frequently in the early stage is useful.
2. Evacuation of the pus by pulling the involved lash or incising the abscess is advised.
3. Antibiotic eyedrops and ointment are applied to control and prevent infection.
4. Systemic broad-spectrum antibiotics may be useful.
5. Analgesics and anti-inflammatory drugs control pain and inflammation.

CHALAZION (TARSAL OR MEIBOMIAN CYST)

Chalazion is a chronic granulomatous inflammation of the meibomian gland.

Etiology
1. It is probably due to chronic irritation caused by an organism of low virulence. The glandular
tissue is replaced by granulation tissue containing giant cells predominantly.
2. It is often multiple in number occurring in crops.
3. It is more common in adults than in children.
408 Basic Ophthalmology

Symptoms
1. There is no pain unless chalazion is secondarily infected.
2. There is disfigurement due to the presence of swelling in the lid.
3. It may be single or multiple in number.

Signs
1. A small non-tender hard swelling in the lid, slightly
away from the lid margin is seen.
2. There are no signs of acute inflammation.
3. On everting the lid, the conjunctiva over the swel-
ling is red or purple. It is grey in colour in later
stages. It may be yellow when secondarily
infected by pyogenic organisms.

Course
1. Complete spontaneous resolution may occur rarely.
2. The contents of the chalazion may be extruded through the conjunctiva occasionally which
resembles a fungating mass.
3. Marginal chalazion—The granuloma is formed in the duct of the gland which projects as a
reddish-grey nodule on the intermarginal strip.
4. Recurrence may occur in seborrhoeic dermatitis, acne rosacea and malignant change.

Treatment
1. It is incised and thoroughly scraped.
• The conjunctiva and lid are anaesthetised with procaine.
• The lid is everted and chalazion clamp is fixed at the site of maximum discolouration with the
hollow side facing the conjunctiva.
• A small vertical incision is given with a sharp blade over the conjunctival side.
• The semifluid contents escape and walls of the cavity are thoroughly scraped with the chalazion
scoop. The cavity is cauterized with carbolic acid to avoid recurrence.
• Bleeding stops and usually no dressing is necessary.
2. Injection of triamcinolone directly into the chalazion may cause complete resolution.
 The Lids 409

DIFFERENCES BETWEEN STYE (HORDEOLUM), CHALAZION AND INTERNAL HORDEOLUM

STYE (HORDEOLUM) CHALAZION INTERNAL HORDEOLUM
1. Onset Acute Chronic Acute meibomian gland
2. Gland Zeis’s gland Meibomian gland Suppurative
3. Type of Suppurative Granulomatous Severe pain
inflammation
4. Symptoms Acute pain and Painless Yellow point seen on
swelling Disfigurement everting the lid
5. Signs Localised, hard (pus) Hard swelling away Vertical incision and
and tender swelling from lid margin drainage
near the lid margin
6. Treatment Hot fomentation Vertical incision Antibiotic and analgesic
Antibiotic and and drainage
Removal of eyelash

INTERNAL HORDEOLUM
It is an acute suppurative inflammation of the meibomian gland. It is uncommon.

Etiology
It occurs due to the secondary infection of the chalazion.
Symptoms
These are more violent than the stye because the gland is larger and it is embedded deeply in the
dense fibrous tissue.
Signs
1. A yellow spot (pus) is seen shining through the conjunctiva on everting the lid.
2. It may burst through the duct, conjunctiva or the skin rarely.
Treatment
It is same as for the stye but the infected chalazion is incised vertically from the conjunctival side.

Section of the upper eyelid showing normal and abnormal position of tarsus and eyelashes

ANOMALIES IN THE POSITION OF LIDS

TRICHIASIS
Trichiasis is a condition where the eyelashes are misdirected backwards rubbing against the cornea.
A few eyelashes or whole lid margin may be involved.
410 Basic Ophthalmology

Etiology
1. Entropion due to cicatrization in stage IV of trachoma is a common cause.
2. Spastic entropion in old persons or due to tight bandaging may cause trichiasis.
3. Blepharitis specially the ulcerative form may result in trichiasis.
4. It may occur after recurrent stye.
5. Scars of the lid following burn, injury or operation may cause trichiasis.

Symptoms
1. There is foreign body sensation and photophobia due to corneal involvement.
2. Irritation, pain and lacrimation are very troublesome.
3. Conjunctival congestion is present usually.

Signs
1. Reflex blepharospasm and photophobia are seen in cases of corneal involvement.
2. Superficial corneal opacities are often present.
3. Ciliary congestion is often associated.

Complications
Recurrent erosion and corneal ulcer are common complications.

Treatment
1. Isolated cilia Trichiasis and corneal ulcer

i. Epilation or removal of misdirected eyelash is repeated every few weeks.

ii. Electrolysis—It is preferable as it causes destruction of hair follicle by a current of 3-5 mA
for 10 seconds. It may be repeated every few months.
2. Whole lid margin involvement—Operative procedures as for entropion are employed.

ENTROPION
It is a condition in which the lid margin rolls inwards.

Types
There are two main types of entropion—spastic and cicatricial.

Etiology
1. Spastic entropion Spastic entropion
i. It is due to the spasm of the orbicularis oculi muscle as may occur after tight bandaging after
operation or following chronic irritative corneal condition.
ii. It commonly occurs in old people involving the lower lid.