Bite-sized practical advice for busy GPs
Styes are the most common eyelid swelling, especially in children. They are due to a staphylococcal infection of the lash follicle, where there are modified sebaceous glands known as glands of Zeiss. It is these sebaceous glands that become infected to produce an acute tender red swelling at the lid margin. Many discharge spontaneously, especially when the lash is pulled out. If not, hot steam bathing usually does the trick and an antibiotic ointment may prevent secondary infection.
Meibomian cysts are common in all age groups. They are caused by blockages of the duct of meibomian glands, which are modified sebaceous glands. The orifices of these glands open on the lid margin and when blocked will sometimes become infected and produce an inflammatory granuloma. When acute they may discharge spontaneously, but hot steam and antibiotic ointment sometimes prevents granuloma formation. Once a granuloma has formed, incision and curettage are needed.
The lid margin is also home to modified sweat glands known as glands of Moll. When the ducts of these glands become blocked a clear cystic swelling develops on the lid margin. This is known as a cyst of Moll and is treated simply by puncturing with a No 1 needle.
The sebaceous glands inside the lash follicle can also become obstructed to produce a white swelling on the lid margins cysts of Zeiss. These can be punctured with a
No 1 needle, but if they recur cautery to the base may be required.
Molluscum contagiosum lesions can occur on eyelids, especially in children. The classical sign is the umbilicated appearance of the nodule. They are due to a viral infection. Many disappear spontaneously but if they are persistent, cauterisation or shave excision is necessary.
Keratoacanthoma is a rapidly growing tumour on the lid. Uncommon, it appears as a red papule often over a short period, sometimes days, and spontaneously resolves. It is important to distinguish it from a squamous cell carcinoma.
Dacrocystitis is an acute infection of the lacrimal sac and can be acute or chronic. It presents as an acutely tender swelling at the medial canthus and is often associated with a surrounding cellulitis. Treatment is with broad-spectrum antibiotics, but occasionally surgical drainage is required.
Basal cell carcinomas are the most common skin tumour and often occur on the eyelids. They present as solid, sometimes telangectatic, nodules with a raised pearly border. Growth is usually slow and it is not until they are well established that ulceration occurs. Early diagnosis is important.
Squamous cell carcinoma is much less common. It is a more aggressive tumour and metastasises to local lymph nodes. It is more common on the lower lid, and can mimic other conditions such as keratoacanthoma and basal cell carcinoma.
Dermoid cysts arise from embryonic epidermis appearing subcutaneously. They present in childhood as a round nodule in the superotemporal area of the orbit. Deeper cysts occur in older age groups and can extend into the orbit,
Paul Payne is a GP in Bristol and a hospital practitioner at Bristol Eye Infirmary