meibomian cyst (also known as a chalazion) is a sterile, inflammatory granuloma caused by the obstruction of a sebaceous gland.
meibomian glands (located in the tarsal plate) are a set of glands that run along the eyelid margin. They produce a lipid secretion which provides the lipid layer of the tear film.
Complications
Diagnosis
Differential
Referral
Risk Factors
Chronic blepharitis.
Seborrhoeic dermatitis.
Rosacea.
Pregnancy.
Diabetes mellitus.
Elevated serum cholesterol.
Chronic hordeola (styes).
Large meibomian cysts can cause astigmatism and visual disturbance.
Rarely cysts can become secondarily infected.
Periorbital cellulitis is caused by an infection anterior to the orbital septum. It does not cause visual impairment, limited or painful eye movements, oedema of the conjunctiva or protrusion of the eyeball. There may be associated fever and malaise.
Orbital cellulitis is an infection involving the deep soft tissue surrounding the eyeball, located posterior to the orbital septum. It usually presents as an acute onset of unilateral eyelid oedema, with a red and painful eye. It is often associated with severe pain, blurred vision, double vision, limited and painful eye movements, protrusion of the eyeball, headache, fever, and malaise. It is a medical emergency, which can progress rapidly and lead to loss of vision and cerebral complications (such as meningitis and cerebral abscess).
eyelid is everted
vision is normal
most commonly found on the upper eyelid, usually 2–8 mm in diameter. Is most commonly sited away from the lid margin. Can affect one or both eyes (more than one meibomian cyst may be present). It may rupture through the skin.
may be signs of minor conjunctival infection secondary to mechanical irritation or manipulation of the eye by the patient.
a firm, painless, localized eyelid swelling that has developed slowly over several weeks.
consider recurrent meibomian cysts could be
Stye (hordeola) — suggested by an acutely painful pustule located either at the eyelid margin (an external stye, caused by infection of an eyelash follicle) or in the tarsal plate (an internal stye, caused by infection of a meibomium gland)
Dacryocystitis (an infection of the lacrimal sac caused by a blocked nasolacrimal duct) — suggested by a very tender, swollen, and fluctuant mass located below the medial canthus. Palpation of the sac may express pus from the lacrimal puncta. The person may report history of a watery eye
Blepharitis — suggested by redness of lid margins and crusting on the eyelids, with a history of bilateral ocular burning, itching, foreign body sensation, and photophobia.
Malignant eyelid tumours: BCC or SCC
Management (Primary care)
Urgent hospital admission If there are signs and symptoms of associated orbital cellulitis,
Urgent Specialist assessment -if red flags or symptoms to suggest malignancy
if uncertainty of diagnosis or recurring cysts- referral to ophthalmology
self care advice
warm compress, massage the cyst
usually self limiting
usually does not require topical or oral abx