From the Guidelines
The patient likely has blepharitis, and management should include warm compresses and eyelid cleansing, which may provide symptomatic relief. The patient can apply warm compresses to the affected area for several minutes to soften adherent scurf and scales or discharge and/or warm the meibomian secretions, as recommended in the 2024 blepharitis preferred practice pattern 1. This can be accomplished by using hot tap water on a clean washcloth, over-the-counter heat pack, or homemade bean/rice bag that can be heated in the microwave.
Key Treatment Options
- Warm compresses
- Eyelid cleansing, including eyelid massage in cases of meibomian gland dysfunction (MGD) to express the meibomian glands
- Artificial tears
- Topical perfluorohexyloctane
- Antibiotics (topical and/or systemic)
- Antiparasitic medication (metronidazole, ivermectin, lotilaner)
- Topical anti-inflammatory agents (e.g., corticosteroids, cyclosporine)
- In-office procedural treatments (e.g., vectored thermal pulsation, microblepharoexfoliation) Eyelid cleansing can be accomplished by brief, gentle massage of the eyelids, and eye cleaners with hypochlorous acid at 0.01% have a strong antimicrobial effect, which has been used for the treatment of both anterior and posterior blepharitis 1. The patient should avoid using compresses that are so hot that they burn the skin, and the ophthalmologist should consider the patient’s ability to perform this treatment and tailor the therapeutic plan accordingly.
Additional Considerations
- Proper counseling of patients with neurotrophic corneas is important in order to avoid injury to corneal epithelium
- A schedule of regularly performed eyelid cleansing, daily or several times weekly, often blunts the symptoms of chronic blepharitis
- Once- or twice-daily warm compresses and massage, at a time most convenient for the patient, is generally adequate
- Expression of the meibomian glands may be particularly helpful in cases of MGD, but it must be performed with care to avoid frequent manipulation of the eyelid, which may lead to further complications 1.
From the Research
Possible Causes of the Tender Lump
- The lump on the upper eyelid towards the inner canthus could be a chalazion, which is a non-inflammatory process that develops due to retained secretion of the meibomian or Zeis glands 2.
- It could also be a hordeolum, which is an inflammatory eyelid tumor that can occur in association with underlying diseases causing Meibomian gland dysfunction and/or chronic blepharitis 3.
- Other possible causes include a lacrimal gland ductal cyst complicated by abscess formation, although this is less likely given the location of the lump 4.
- A migrated hard contact lens is also a possible cause, although this is rare and typically occurs in patients who have undergone previous eye surgery 5.
Management Options
- Treatment for a chalazion may include application of warm compresses onto the eyelids, lid hygiene, using local antibiotic ointment with or without steroids, injecting steroid solution into the lesion, and surgical removal of the lesion by incision and curettage 2.
- For hordeolum and chalazion, the majority of lesions resolve spontaneously over time, but in some instances, surgical intervention may be necessary 3.
- In persistent, recurrent, or clinically atypical cases, malignant tumors must be excluded as a differential diagnosis by excisional biopsy and histopathological assessment 3.
- There is currently no commonly agreed treatment of choice for chalazion, and the management may vary among clinicians 2.