Lid Swellings

Ophthalmology Practicals Viva

1. LID SWELLINGS (CHALAZION)
1) what are the positive findings in your case?
@ a ______ years boy/ girl noticed a painless small swelling on left/ right upper/ lower lid since ___
months..on examination a well localized round swelling is present at junction of medial two third and
lateral one third of lid. It measures approximately 8mm in diameter. It is firm smooth and non tender.
overlying skin is free, on aversion of lid a purple lesion is seen on palpebral conjunctiva corresponding to
external swelling. Anterior segment is normal. visual acuity is 6/6 (location, shape, size, firmness,
tenderness overlying skin and underlying conjunctiva should be explained)
2) what is chalazion?
@ it is a chronic non infective inflammation of meibomian gland
3) what is the aetiology of chalazion?
@ obstruction of duct of meibomian gland and low grade infection in it plays an important role in chalazion
4) what are the risk factors for occurrence of chalazion?
@ blepharitis, chronic conjunctivitis, uncorrected refractive error, diabetic mellitus are considered risk
factors.
5) what is histopathology of chalazion?
@ histopathology show that entire meibomian gland is replaced by granulation tissue containing giant cells
6) what is the state of long standing chalazion if untreated?
@ spontaneous resolution, granuloma formation, secondary infection leading to hardeolum internum,
malignant transformation into meibomian gland carcinoma, large chalazion of upper lid causes astigmatism,
large chalazion of lower lid causes aversion of punctum leading to watering from the eyes, ectropion, it can
burst on conjunctival side forming a fungating mass of granulation tissue, calcification

2. 7) how many meibomian glands are present in eye?
@ 30-40 in upper lid, 20-30 in lower lid
8) what is the function of meibomian gland?
@ meibomian gland contributes for formation of lipid layer of tears which prevents the evaporation of
tears and provide stability to tear film by increasing its surface tension
9) what are the other lid swellings you know?
@ hardeolum externum, hardeolum internum, meibomian gland carcinoma, molluscum
contagiosum, viral warts, benign tumours of eye lids like papiloma, xanthelasma, haemangioma,
neurofibroma, keratokanthoma, pre malignant tumours like actinic keratosis, xeroderma pigmentosa,
malignant tumours like basal cell carcinoma squamous cell carcinoma, sebaceous gland
carcinoma, malignant melanoma.
10) what are the glands present in lids?
@ glands of meibomian glands of moll and glands of Zeis, glands of wolfring, glands of manz, glands
of krause
11) what is hardeolum internum?
@ it is an suppurative inflammation of meibomian gland.
12) what is hardeolum externum?
@ it is an acute suppurative infection of Zeis gland
13) what is stye?
@ it is an hardeolum externum
14) how will you differentiate hardeolum internum from chalazion?
@ by presence of pain and acute signs of inflammation
15) how will you differentiate hardeolum externum from hardeolum internum?
@ on examination hardeolum internum is differentiated from hardeolum externum by fact that
maximum tenderness and swelling in hardeolum externum is near lid margin at root of cilia and in
hardeolum internum is away from lid margin. Pain is more severe in internum when compared to
externum.

3. 16) what is differential diagnosis of chalazion?
@ in elderly patients and in cases of recurrent chalazion adeno carcinoma should be suspected.
17) how will you manage the case of chalazion?
@ -early and small chalazion can be treated conservatively by hot fomentation, topical antibiotic
drops and ointment, and oral anti inflammatory drugs
-intra lesional injection of triamcinolone acetate causes resolution in 50% of cases
-incision and curratage is effective treatment of chalazion.
18) describe the steps in Incision and curratage?
@ --local anaesthesia is applied by installing 4% xylocaine drops in conjunctival sac and infiltration
of lid with 2% xylocaine
--a chalazion clamp is applied fenestrated side on the conjunctival side and lid is averted
--a vertical incision is made to avoid injury to other meibomian gland
--contents are currated out with the chalazion scope
--to avoid recurrence its cavity should be cauterised with carbolic acid
--antibiotic eye ointment instilled and eye is padded
--if swelling is more prominent on skin side, skin side approach can be done, in such cases
horizontal incision is given, however conjunctival approach is preferred due to cosmetic reason
19) why will you give vertical incision on conjunctiva in operating side?
@ if horizontal incision is made, it will cut the ducts of other meibomian glands that are arranged
vertically, to avoid this a vertical incision is given.
20) what is treatment of marginal chalazion?
@ destruction by diathermy is treatment of choice for marginal chalazion.