Makindo Medical Notes

Benign eyelid disorders are common, especially in primary care and ophthalmology clinics. Although usually harmless, they may mimic eyelid tumours or cause significant ocular surface morbidity if untreated. History should explore onset, pain, discharge, systemic associations (e.g. rosacea, dyslipidaemia), and impact on vision. Examination must include inspection of the lid margin, lashes, conjunctiva, cornea, and periocular skin.

📌 Classification of Benign Eyelid Conditions

• Infective: Hordeolum (stye), preseptal cellulitis (mild cases).
• Inflammatory/Obstructive: Chalazion, blepharitis, meibomian gland dysfunction.
• Structural Malpositions: Ectropion, entropion, trichiasis, dermatochalasis.
• Metabolic/Degenerative: Xanthelasma, senile changes.
• Miscellaneous: Benign tumours (papilloma, seborrhoeic keratosis, cyst of Moll/Zeis).

🔎 Common Benign Conditions

• Stye (Hordeolum): Acute, painful, erythematous swelling at lash follicle (external) or meibomian gland (internal). Pathophysiology: Staphylococcus aureus infection. Management: Warm compresses, lid hygiene, oral antibiotics if spreading.
• Chalazion: Painless, firm nodule from blocked meibomian gland; may follow a stye. Management: Warm compresses; incision & curettage or intralesional steroid if persistent.
• Blepharitis: Chronic lid margin inflammation (anterior – staphylococcal/seborrhoeic; posterior – meibomian dysfunction). Symptoms: Grittiness, crusting, lash loss, recurrent chalazia. Management: Lid hygiene, warm compress, lubricants; topical fusidic acid/chloramphenicol if infected; oral doxycycline for severe posterior blepharitis.
• Xanthelasma: Yellow, soft cholesterol-rich plaques at medial canthus; often cosmetic but may indicate dyslipidaemia. Management: Lipid profile, cardiovascular risk assessment; excision, cryotherapy, or laser for cosmesis.
• Dermatochalasis: Redundant eyelid skin, usually age-related. May cause visual field obstruction or brow ache. Management: Blepharoplasty if functionally significant.
• Ectropion: Outward turning of lid margin → epiphora, irritation, exposure keratopathy. Usually age-related laxity. Management: Lubricants/taping for mild cases; surgical tightening for definitive correction.
• Entropion: Inward turning of lid margin → lashes abrade cornea (trichiasis) → pain, keratitis, ulcer. Management: Lubricants, botulinum toxin or temporary sutures; surgical repair for persistent cases.
• Benign Eyelid Tumours: Papilloma, seborrhoeic keratosis, epidermoid cyst, cysts of Moll/Zeis. Typically slow-growing, non-invasive. Management: Excision if symptomatic or for histology if atypical.

🧪 Investigations (when indicated)

• Lipid profile → in xanthelasma, especially if young.
• Histopathology → for any atypical, recurrent, or suspicious lesion.
• No investigations needed for typical stye/chalazion/blepharitis.

⚠️ Red Flags – Consider Malignancy if:

• Loss of lashes (madarosis) or distortion of lid margin.
• Recurrent “chalazion” in same location.
• Ulceration, bleeding, or induration.
• Failure to respond to standard management.

💡 Exam Pearls

• Stye = painful, Chalazion = painless lump.
• Blepharitis is a chronic cause of gritty eyes and recurrent chalazia.
• Xanthelasma = benign but screen lipids and CVS risk.
• Entropion is more vision-threatening than ectropion (corneal damage).
• Always check cornea and vision in lid disorders.

👁️ Case Scenarios — Benign Eyelid Conditions

🧑‍⚕️ Teaching Commentary

Benign eyelid conditions are common in primary care and ophthalmology. • Chalazion is a granulomatous blockage of a Meibomian gland → firm, painless nodule. • Stye (hordeolum) is an acute staphylococcal infection → red, tender swelling. • Blepharitis is a chronic inflammation of the lid margins → recurrent irritation, crusting, and foreign-body sensation. 🌟 Key principles: reassure the patient, encourage lid hygiene and warm compresses, and reserve surgery or antibiotics for refractory or infected cases.