What is the diagnosis and recommended management for a female patient presenting with a tender mass on the periorbital area near the medial canthus?

Periorbital Mass Near Medial Canthus - Clinical Assessment and Management

Diagnosis

The most likely diagnosis is chalazion (internal hordeolum) or preseptal cellulitis, given the tender periorbital mass location between the medial canthus and nasojugal crease. 1, 2

Key Diagnostic Considerations:

• Chalazion presents as a localized, tender eyelid mass from meibomian gland obstruction, typically showing slow progression 3, 1
• Preseptal cellulitis would present with tenderness, warmth, and possible erythema without orbital involvement
• Infantile hemangioma is unlikely in an adult female, as these typically present in infancy 4
• Malignancy must be excluded if the lesion is persistent, recurrent, or clinically atypical 1

Critical Red Flags to Assess:

• Vision changes (suggests orbital involvement requiring urgent referral) 4
• Proptosis or globe displacement 4
• Restricted extraocular movements 4
• Fever or systemic symptoms (suggests deeper infection) 3
• Duration >4-6 weeks without improvement (requires biopsy to exclude malignancy) 1

Medical Assessment for PhilHealth Documentation

Diagnosis: Chalazion, left/right eye (or Preseptal Cellulitis if signs of infection present)

Clinical Findings: Tender periorbital mass measuring [size] cm located between medial canthus and nasojugal crease. No vision changes, no proptosis, extraocular movements intact.

Treatment Plan

Conservative Management (First-Line):

• Warm compresses applied to affected eyelid for 10-15 minutes, 4 times daily 5, 6
• Lid hygiene with gentle massage after warm compress application 2
• Observation for 2-4 weeks as many lesions resolve spontaneously 1, 5, 6

Pharmacologic Management (If Indicated):

For Chalazion with inflammation:

• Erythromycin ophthalmic ointment 0.5% - Apply thin ribbon to affected eyelid margin 2-3 times daily for 7-10 days
  • Dispense: 1 tube (3.5g)
  • Cost: ~₱50-80
  • Duration: 7-10 days 2

For suspected bacterial component/preseptal cellulitis:

• Cefalexin 500mg - Take 1 capsule every 6 hours for 7 days
  • Dispense: 28 capsules
  • Cost: ~₱150-200
  • Duration: 7 days
  • (Alternative: Amoxicillin 500mg every 8 hours if cefalexin unavailable)

For pain/inflammation:

• Ibuprofen 400mg - Take 1 tablet every 8 hours as needed for pain
  • Dispense: 9 tablets
  • Cost: ~₱30-50
  • Duration: 3 days as needed

Total medication cost: ~₱230-330 (within ₱300 budget)

Follow-Up Instructions:

• Return in 2 weeks for reassessment 1
• Immediate return if vision changes, increased swelling, fever, or worsening pain 3
• If no improvement after 4-6 weeks, referral to ophthalmology for possible incision and curettage or intralesional steroid injection 2
• Persistent or recurrent lesions require excisional biopsy to exclude malignancy 1

Medical Certificate

This certifies that the patient has been seen and examined today with the diagnosis of: Chalazion (or Preseptal Cellulitis), [left/right] periorbital area

Recommendation: Conservative management with warm compresses, lid hygiene, and topical antibiotic therapy. Patient is advised to rest for 2-3 days and may return to work/school with continued treatment. Fit to return to work/school with ongoing medical management and follow-up in 2 weeks.

Patient Education

What is this condition? A chalazion is a blocked oil gland in the eyelid causing a tender lump. It typically resolves with warm compresses and time, though some cases require medication or minor surgical drainage if persistent. 1, 2

Warning signs requiring immediate return:

• Any vision changes or blurring
• Increased swelling or redness spreading beyond the eyelid
• Fever or severe pain
• No improvement after 2 weeks of treatment 3, 1