What are the possible causes and treatments for a bump on the eye?

Bump on the Eye: Causes and Treatment

A bump on the eye most commonly represents a chalazion (blocked meibomian gland), hordeolum (stye), pinguecula, or pterygium, with treatment ranging from warm compresses and lid hygiene for inflammatory lesions to surgical excision for persistent or vision-threatening growths.

Common Eyelid Bumps

Chalazion and Hordeolum

• Initial management consists of warm compresses applied 4 times daily for 10-15 minutes and eyelid hygiene to promote drainage of blocked meibomian glands 1
• Most cases resolve spontaneously within 2-4 weeks with conservative therapy 1
• Persistent lesions beyond 4-6 weeks may require incision and curettage by an ophthalmologist 1
• Topical antibiotics are generally not indicated unless secondary infection develops with surrounding cellulitis 1

Giant Papillary Conjunctivitis (GPC)

• Contact lens wearers who develop bumps on the inner upper eyelid (papillae) should discontinue lens wear immediately until the conjunctiva returns to normal 1
• Treatment includes replacing lenses more frequently, decreasing wearing time, using preservative-free lens care systems, and administering mast-cell stabilizing agents 1
• Protruding suture knots from prior surgery can cause similar bumps and require removal, rotation, or coverage with a therapeutic contact lens 1

Conjunctival Surface Bumps

Pinguecula and Pterygium

• These are benign growths of conjunctival tissue, typically on the nasal side of the eye 1
• Mild inflammation responds to lubricating drops and short courses of topical corticosteroids if needed 1
• Surgical excision is reserved for cosmetic concerns, chronic irritation, or visual axis involvement 1

Infectious Causes

• Any bump associated with purulent discharge, severe pain, or marked inflammation requires conjunctival cultures and Gram stain to rule out gonococcal or severe bacterial infection 2, 3
• Gonococcal conjunctivitis requires systemic antibiotics (ceftriaxone 125 mg IM plus azithromycin 1 g PO) in addition to topical therapy 2, 3
• Broad-spectrum topical antibiotics (such as polymyxin B-trimethoprim or fluoroquinolones) can be used for bacterial conjunctivitis, though observation is acceptable for mild cases 3, 4

Red Flags Requiring Immediate Ophthalmology Referral

Urgent ophthalmologic evaluation is mandatory for:

• Visual loss or decreased vision 3, 5
• Moderate to severe eye pain 2, 3
• Corneal involvement detected with fluorescein staining 2, 3
• Severe purulent discharge suggesting gonococcal infection 2, 3
• Lack of response after 3-4 days of appropriate therapy 2, 3
• History of immunocompromise 2
• Recurrent episodes or history of herpes simplex virus eye disease 2, 3

Critical Pitfalls to Avoid

• Never prescribe topical corticosteroids without ruling out herpes simplex virus, as this can lead to corneal perforation and permanent vision loss 3
• Do not assume bilateral periorbital swelling around a bump is purely cosmetic—this may indicate systemic disease requiring renal, cardiac, hepatic, or thyroid evaluation 6
• Avoid contact lens wear during any active conjunctival inflammation or infection 3
• Do not overlook the possibility of contact lens-related complications in lens wearers, as therapeutic bandage contact lenses carry increased risk of infectious keratitis despite antibiotic prophylaxis 1

Patient Education

• Practice strict hand hygiene to prevent transmission to others or the unaffected eye 2, 3
• Avoid sharing towels, pillows, or eye makeup 3
• Patients may return to work or school after 24-48 hours of antibiotic treatment if symptoms are improving 3
• Complete resolution typically occurs within 7-10 days with appropriate treatment 3