Internal stye picture: Pictures of Styes and Chalazia in Your Eye
Stye (Hordeolum and Chalazion) in Adults: Condition, Treatments, and Pictures – Overview
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Images of Hordeolum (Stye) and Chalazion
A stye (hordeolum) is a local, acutely inflamed growth (swelling, lesion) of the eyelid. They can occur at the lid margin or farther up the lid on either the inner (tarsal) side or the outer (skin) side of the lid. A chalazion is the chronic form of a stye, and its cellular makeup is different than that of a stye.
Both the meibomian and sebaceous oil glands of the lid can be involved in this process, which begins with a blockage of the normal openings of these glands, leading to the swelling. Typically, there is bacterial contamination.
Who’s at risk?
Styes and chalazions are extremely common. You are more likely to have this problem if you have:
- Dry skin problems
- Acne rosacea
- Poor lid hygiene
- Incomplete removal of eye makeup
- Outdated or infected cosmetics
- Increased stress
- Hormonal changes
Signs and Symptoms
One should be suspicious of having a stye when there is the rather rapid development of a pus-filled bump (pustule) or swelling on the edge of the eyelid or on the lid itself. Chalazions are more of a rounded lump and are harder in consistency.
Some of the things you may experience include:
- Redness of the eye
- Discharge from the swelling
- Tenderness to touch
- Very mild blurring of vision
- Burning sensation
- Scratchy feeling in the eye
- Drooping of the eyelid
- Crusting of the eyelid edges
Apply frequent (4–6 times daily) very warm compresses until there is no more drainage from the stye or chalazion. The compresses must be hot enough to help drain the growth yet not so hot as to burn the very delicate eyelid skin. It usually takes 7–10 days, at most, for the problem to resolve. Good lid hygiene is also mandatory. Over-the-counter ointments or drops have no treatment value.
Note: Recurring styes or chalazions without other related factors suggest possible serious disease. With the start of very warm compresses, the growth may get larger temporarily before draining.
When to Seek Medical Care
You should seek medical advice if:
- The eyelids are swollen shut.
- There is no improvement after using frequent very warm compresses for 10–14 days.
- There is pus or very thick drainage from the eye.
- Pain or tenderness is increasing despite compresses.
- The swelling is increasing beyond the first 2–3 days.
- The eyelid is hot to the touch.
- You develop a fever.
- Recurrences are frequent, especially at the same location.
- Progressive vision changes are experienced, including double vision.
Treatments Your Physician May Prescribe
Treatment may involve any or all of the following:
- Surgical incision and drainage
- Injection of steroid into the growth
- Antibiotic ointments
- Antibiotic drops
- Oral antibiotics (especially if there is possible lid infection suspected)
- Treatment for underlying/contributing conditions such as dandruff, acne rosacea, psoriasis, etc.
MedlinePlus: Eye Diseases
MedlinePlus: Eyelid Disorders
Clinical Information and Differential Diagnosis of Hordeolum (Stye) and Chalazion
Kanski JJ, Nischal KK, eds. Ophthalmology: Clinical Signs and Differential Diagnosis. pp. 17, 91. Philadelphia: Mosby, 1999.
Yanoff M, Duker JS, eds. Ophthalmology. 2nd ed, pp. 708-709. St. Louis, MO: Mosby, 2004.
Sty/Stye (Hordeolum): Symptoms, Causes, Treatments
A sty is a red, painful bump that forms either on or inside the eyelid near the edge of the eyelashes.
What is a sty?
A sty (sometimes spelled “stye”) is a red, painful bump that forms either on or inside the eyelid near the edge of the eyelashes. A sty that appears on the outside of the upper or lower eyelid, the more usual location, is called an external sty. A sty that appears on the inside of the upper or lower eyelid is called an internal sty. A sty can look like an acne pimple.
The medical term for a sty is a hordeolum.
A sty is similar to another bump that occurs in the eyelid called a chalazion. A chalazion is a bump that usually occurs farther back on the eyelid. Unlike a sty, a chalazion is usually not painful and is not caused by a bacterial infection. Instead, a chalazion occurs when the opening of the oil-producing glands in the eyelid becomes clogged. Treatment for both conditions, however, is similar.
Symptoms and Causes
What causes a sty?
A sty is caused by a bacterial infection in the oil-producing glands in the eyelid. Oil-producing glands line the eyelids and help lubricate the surface of the eye.
What are the signs and symptoms of a sty?
Signs and symptoms of a sty include:
- Painful red bump along the edge of the upper or lower eyelid near the base of the eyelashes
- Swelling of the eyelid (sometimes the entire eyelid)
- Crusting along the eyelid
- Sensitivity to bright light
- Sore, scratchy eye
- Tearing of the eye
- A feeling that there is something in the eye
Diagnosis and Tests
How is a sty diagnosed?
A sty is usually diagnosed by a visual exam of the eyelid.
What are the risk factors for developing a sty?
Styes are very common. Anyone can get a sty. However, you may be more likely to get a sty if you:
- Have had a sty before
- Have blepharitis (an inflammation of the eyelids)
- Have certain skin conditions, such as acne rosacea or seborrheic dermatitits
- Have diabetes
- Have dry skin
- Are experiencing hormonal changes
- Have high lipid levels (“bad” cholesterol)
Management and Treatment
What are the treatments for a sty?
A sty usually will disappear on its own in a few days. However, to reduce the pain and swelling, a sty can be treated at home with self care. Treat as follows:
- Apply a warm washcloth to the eyelid. Apply for 10 to 15 minutes at a time, 3 to 5 times a day. Rewarm washcloth as needed by soaking it in warm water. Wring out excess water, then reapply to the eyelid.
- Gently wipe away eyelid drainage with mild soap such as Johnson’s baby shampoo and water, or eyelid wipes (available in drug stores).
Also follow these tips:
- Do not squeeze or pop a sty.
- Do not rub or touch your eyelid.
- Do not wear makeup or contact lenses until the area has fully healed.
A sty that does not improve within 48 hours of self care may require medical treatment by a doctor. Treatments given by doctors include:
- In-office incision (under local anesthesia) to drain the sty
- Antibiotic ointment to apply to the eyelid or antibiotic eye drops. Sometimes antibiotic pills are prescribed if there is infection of the area surrounding the eye or after incision and drainage of an internal sty.
- Steroid injection into the sty to reduce the swelling in the eyelid
Can styes be prevented?
The best way to prevent a sty is by practicing good hygiene around your face and eyes, including:
- Wash your hands thoroughly and often and especially before touching your face and eyes.
- Wash your hands before and after removing contact lenses. Clean contacts with disinfectant and lens cleaning solution. Discard daily wear or other “limited use” lenses on the schedule recommended by your eye doctor.
- Wash your face to remove dirt and/or makeup before going to bed.
- Throw away all old or expired makeup. Replace mascara and eye shadow every 2 to 3 months. Never share or use another person’s makeup.
When should I see my eye doctor about a sty?
See your eye doctor if:
- Your eye is swollen shut due to the swelling in the eyelid
- Pus or blood is leaking from the bump
- Pain and/or swelling increases after the first 2 to 3 days
- Blisters have formed on your eyelid
- Your eyelid feels hot
- Your vision has changed
- Styes keep recurring. If this happens, a biopsy (a small piece of the sty) may need to be taken to rule out other more serious problems.
Eye Stye | Causes and Treatment
What is an eye stye?
Plaksta mala bez iekaisuma – Edge of the eyelid without inflammation
Plaksta malas apsartums un tūska – Redness and swelling of the edge of the eyelid
Zvīņveida aplikums – Scaly plaque
Types of blepharitis
There are different types of blepharitis.Anterior blepharitis affects only the skin and ciliary follicles and is most commonly caused by bacteria and the toxins they produce. In turn, posterior blepharitis is more severe, since it also affects the lining of the eyelid, and this causes changes in the work of the eyelid glands and their clogging.
The development of chronic blepharitis can be promoted by smoking, chemical gases, polluted air, etc., as well as general diseases such as skin disease – rosacea, allergic dermatitis, psoriasis and the like.Blepharitis is more common in people suffering from diseases of the digestive system, imbalances in thyroid hormones and impaired immunity.
Plaque on eyelashes
Clogging of the meibomian glands
Redness and swelling of the eyelid margin
What are the symptoms of blepharitis?
Usually blepharitis manifests itself in the form of: redness of the eyelids and eyes, a burning sensation or a foreign object in the eye, discharge from the eyes, plaque on the eyelashes and in the corners of the eyes, photophobia or even blurred vision.In severe and prolonged cases, there is also a thickening of the eyelid margin and peeling of the skin.
In the case of chronic blepharitis, these symptoms may be constant or periodically become less pronounced, and recover over time.
How is blepharitis diagnosed?
The diagnosis of the disease is based on the patient’s complaints and the microscopic picture of the eye. In some cases, eyelashes are taken for analysis to diagnose ciliary mites, or a smear from the eyelid is taken for microbiological analysis.
How is blepharitis treated?
Treatment is based on regular cleaning and hygiene of the eyelid margins. Drug therapy is necessary only in cases where an infection is added to the disease. Systemic antibiotics are more often prescribed for posterior blepharitis, as well as for patients with reduced immunity or with an aggressive bacterial infection.
How to perform eyelid hygiene in case of blepharitis?
Eye health improves the use of warm compresses, which are applied to the eyelids.Heat acts on the clogged glands at the edges of the eyelids, and the fatty layer in them becomes more fluid and begins to stand out better. Instead of compresses, you can also use special hot-cold glasses, which can be purchased from specialized medical institutions and which are also available at the Latvian American Eye Center.
It is possible to carry out mechanical cleaning of the edges of the eyelids – remove plaque, as a result clogged glands open. The edges of the eyelids are cleaned with special wipes or cotton swabs and baby shampoo.It is important to cleanse the edge of the eyelid, not the skin or conjunctiva. Cleansing should be gentle so as not to injure the edge of the eyelid.
In the case of posterior blepharitis, eyelid massage is a good tool to restore eye health. The eyelid massage can be done gently by massaging the eyelid with your finger towards the eyelashes.
After performing the above procedures, a little antibacterial ointment prescribed by your doctor can be applied to the edges of the eyelids. Typically, the ointment is used within two weeks.Be sure to consult with an ophthalmologist about the need for long-term use of the ointment. After acute symptoms have subsided and if necessary, your doctor will prescribe a disinfectant ointment or gels that can be used for a long time.
In all cases of blepharitis, moisturizing of the eye surface is required.
What else can you do to help?
Given the widespread prevalence of the disease, the medical industry is looking for new ways to help patients with chronic blepharitis.Fast and modern help for chronic inflammation of the eyelid margins or blepharitis, which is also available at the Latvian American Eye Center – eyelid hygiene using the new generation BlephEx equipment. The device is a pen-like instrument with a “micro-sponge” at the end, which, rotating around its axis, cleans both the edges of the eyelids and eyelashes from plaque and old skin cells, as well as microbes.
Benefits of eyelid hygiene with BlephEx:
– the procedure lasts 10-15 minutes;
– painless procedure;
– cleansing plaque from the edges of the eyelids and eyelash roots;
– ensuring access of medicines to the site of inflammation;
– improving the functioning of the glands of the eyelids;
– Sterile, disposable cleaning tips are used during the procedure.
Various versions of warm eye compresses
Cleaning the edge of the eyelids with a cotton swab
Cleaning the eyelids with Blephex
Edge of the eyelid before and after cleaning with Blephex
90,000 Barley (disease) is … What is Barley (disease)?
Barley ( hordeolum ) – acute purulent inflammation of the hair follicle of the eyelash or Zeiss sebaceous gland, which is located near the bulb of the eyelashes.There is also a so-called. internal barley , when the meibomian gland lobule becomes inflamed. Symptoms of both forms are inflammation and swelling of the edge of the eyelid, redness, soreness. Barley is caused by a bacterial infection (in 90-95% of cases – Staphylococcus aureus  ) and is most often observed with weakened immunity (for example, after colds).
Course of the disease
Painful, limited swelling, edema, reddening of the eyelid conjunctiva appear at the edge of the eyelid.After 2-4 days, a yellowish head forms at the top of the swelling, upon opening which pus with particles of dead tissue appears. Several barley may appear.
In some cases, headaches, fever, enlargement of the nearest lymph nodes are possible. Extrusion of pus is contraindicated; such an attempt can lead to the spread of infection towards the orbit with the appearance of phlegmon of the orbit, thrombosis of the cavernous sinus of the brain, meningitis, and even death is possible.
A similar clinical picture is observed with inflammation of the meibomian glands – the so-called internal barley, or meibomite , in which, however, the inflammation develops less acutely. Internal barley (meibomite) opens into the conjunctival sac. Sometimes chalazion develops after it – a chronic inflammation of the cartilage around the meibomian gland. The skin is not adhered to form, painless. A purely cosmetic defect worries.
Risk factors for the development of barley are general hypothermia, decreased immunity, vitamin deficiency, endocrine disorders and chronic diseases of the gastrointestinal tract.An important place is occupied by the condition of the eyelids: the presence of demodicosis, blepharitis.
The main prevention of barley on the eye is, first of all, the observance of the rules of personal hygiene. You should try not to touch or rub your eyes with dirty hands. Use individual cosmetics and personal hygiene products (towels, wash tampons, etc.). Also, human immunity plays an important role.
At the beginning of the process, lubricating the skin of the eyelid at the site of infiltration with 70% ethyl alcohol or 1% alcohol solution of brilliant green 3-5 times a day, which often allows to stop the further development of the disease.Instillations of 20-30% sodium sulfacyl solution, 10% sodium sulfapyridazine solution, 1% penicillin solution, 1% erythromycin solution, 0.1% dexamethasone solution, 0.3% prednisolone solution, 1% hydrocortisone emulsion 3-4 times day. Lubrication of the skin of the eyelid in the area of infiltration and laying for the eyelids of ointments containing sulfonamides and antibiotics, 1% yellow mercury ointment.
Compresses and wet lotions are not recommended, since wetting the skin leads to its maceration and the penetration of infection into the openings of the excretory ducts of other sebaceous glands, which can give a recurrent course of inflammation.
With an increase in body temperature and general malaise, you should consult a doctor to decide whether to prescribe antibiotic therapy. If an abscess forms, surgery may be required.
The outlook is generally good. Timely active treatment of barley and associated diseases avoids the development of complications. Patients suffering from recurrent barley should be carefully examined in order to identify possible etiological and predisposing factors. 
90,000 Barley in a child – causes, symptoms, diagnosis and treatment
Barley in a child is a limited accumulation of pus in the hair follicle of the eyelash and associated sebaceous glands of Zeiss, less often in the lobules of the meibomian glands embedded in the thickness of the cartilage of the eyelids. The clinical picture of the disease in a child is characterized by painful edema and hyperemia of the eyelid, the formation of an abscess at the root of the eyelash (external barley) or on the inside of the eyelid (internal barley), followed by opening and release of pus.The diagnosis of barley in a child is established on the basis of a general examination of the eye and eyelids under natural and lateral lighting. With barley in a child, cleansing and disinfection of the infiltrate, the use of eye drops and ointments with antibacterial action, and, if necessary, surgical opening of the abscess are shown.
Barley in a child is an acute local purulent-inflammatory process that affects the hair follicle of the eyelash with the Zeiss sebaceous glands, and sometimes the large meibomian glands of the tarsal-conjunctival plate.Barley in children is often found in the clinical practice of pediatrics and pediatric ophthalmology.
Barley in a child
Barley in a child is an acute local infectious process caused by bacterial microflora, mainly (90-95%) Staphylococcus aureus. Infection of the cavity of the hair sac of the eyelashes and ducts of the sebaceous glands with the development of barley can occur if the child does not follow the rules of personal hygiene, touching and combing the eyelids with dirty hands, using a dirty towel, as well as when wearing contact lenses, swimming in a polluted reservoir.
Infection in the ducts of the sebaceous glands contributes to the clogging of their excretory canals and stagnation of secretions, which aggravates the inflammation. The development of purulent-inflammatory processes on the skin of a child is facilitated by insufficient maturity of immunity and a weakening of protective mechanisms that occurs against the background:
Barley in a child often accompanies other eye lesions (staphylococcal blepharitis, conjunctivitis, dysfunction of the meibomian glands), complicates the course of seborrheic dermatitis in adolescence , acne vulgaris, furunculosis, demodicosis.With HIV infection, there is a chronic course of barley and other bacterial skin infections in children.
Distinguish between external and internal, single and multiple, one- and two-sided barley in a child. External barley in a child is detected more often, it is characterized by a purulent focus on the edge of the outer musculocutaneous plate of the eyelid in the root zone of the eyelashes. With internal barley (meibomitis) in a child, purulent inflammation develops in the thickness of the cartilaginous plate of the upper or lower eyelid with the exit of the abscess on its internal mucous surface, directly adjacent to the eyeball.Formed barley in a child is an accumulation of polymorphonuclear leukocytes and tissue necrosis, i.e. abscess.
Symptoms of barley in a child
The clinical picture of barley in a child is characterized by an acute onset and a rapid increase in symptoms. The formation of external barley begins with the appearance of hyperemia and edema in a limited area of the eyelid in the growth zone of the eyelashes. The child complains of soreness when blinking and touching the site of inflammation, tingling and itching.The eyelid swells and hardens, which leads to a narrowing of the palpebral fissure, sometimes – to the inability to open the eye. The inflammatory infiltrate rapidly increases in size, and on days 2-3, as a result of purulent fusion, an abscess with a yellowish head at the roots of the eyelashes is formed.
After 1-2 days, barley spontaneously breaks out with the release of purulent contents and necrotic tissue particles. In a child, the resolution of barley can occur much faster due to the habit of frequently rubbing the eyes.After opening the barley, the child’s soreness, swelling and hyperemia of the eyelid decreases, by the end of the week the signs of inflammation disappear. In severe cases and with multiple barley, the child may be disturbed by headache, fever, general weakness, accompanied by an increase in the parotid and submandibular lymph nodes (lymphadenitis).
With internal barley (meibomitis) in a child, inflammation develops less acutely, edema and hyperemia become more noticeable with eversion of the eyelid, redness and irritation of the conjunctiva of the eye may occur.With internal barley in a child, the abscess is opened from the inner surface of the eyelid into the conjunctival sac. After spontaneous resolution of internal barley, granulation growths of the eyelid mucosa may appear. With a decrease in the child’s immunity and the presence of foci of chronic infection, inflammation of the eyelids can acquire a protracted course with periodic relapses of barley.
Squeezing out the contents of barley in a child is unacceptable, since it is dangerous to spread a purulent infection with the development of phlegmon of the orbit, thrombophlebitis of the orbital eyelids, thrombosis of the cavernous sinus, in rare cases – purulent meningitis with a risk of death.Barley in a child can turn into a chronic non-infectious lipogranulomatous inflammation of the sebaceous glands of the eyelid – chalazion.
Diagnosis of barley in a child
Diagnosis of barley in a child is established by a pediatric ophthalmologist based on the results of a general examination of the eye and eyelids in natural light and by the lateral illumination method. Biomicroscopy of the eye with internal barley in a child makes it possible to establish the expansion of the mouths of the meibomian glands.
To identify the causes of the recurrent course of barley in a child, a comprehensive examination is carried out with the involvement of a pediatric immunologist, pediatric dermatologist, pediatric gastroenterologist, pediatric endocrinologist.Barley in a child is differentiated with chalazion, dacryocystitis, cysts and tumors of the eyelids. Appointed:
- general analysis of blood and urine,
- determination of blood sugar,
- bacteriological examination of a smear from the conjunctiva (to isolate the pathogen and its sensitivity to antibiotics),
- analysis of feces for eggs of worms,
- study of eyelashes for demodicosis,
- study of the immunological status.
Treatment of barley in a child
At the first signs of barley in a child, you should immediately contact a pediatric ophthalmologist. With an uncomplicated course, barley in a child responds well to treatment and usually goes away in 7-10 days. In most cases, with barley in a child, local conservative therapy is carried out.
- At the beginning of the development of the inflammatory process, cleaning and daily disinfection of the eyelids is performed: treatment with a decoction of chamomile, calendula, extinguishing the infiltrate with 70% ethyl alcohol, 1% solution of brilliant green.
- Before the breakthrough of the head of barley, the child is prescribed thermal procedures for the inflammation focus (dry heat, UFO, UHF), which increase blood flow and natural drainage.
- Instillations are made in the conjunctival sac of eye drops containing antiseptics (solution of sodium sulfacil), antibiotics (solution of chloramphenicol, ciprofloxacin), glucocorticosteroids (solution of dexamethasone).
- Ointment applications of erythromycin and tetracycline ointments under the eyelid continue after opening the barley in the child.
To prevent the infection from spreading deeper when opening the barley, care must be taken that the child does not rub his eyes with his hands. In the case of the development of general symptoms (fever, malaise), antipyretic, sulfa or antibacterial drugs are indicated.
Surgical treatment is required for large external and internal barley, which does not respond to conservative treatment. Under local anesthesia, the child’s barley is opened, followed by daily postoperative treatment of a purulent wound and antibacterial therapy.With a recurrent course of barley, the child is prescribed vitamins, immunomodulators, autohemotherapy.
Forecast and prevention
With accurate and adequate treatment, the prognosis of barley in a child is usually favorable: in most cases, complications do not develop, cure occurs in 1-2 weeks.
Prevention of the development of barley in a child includes hardening, good nutrition, walking in the fresh air, hygiene, sanitation of chronic foci of infection.In case of recurrence of barley in a child, a thorough examination is necessary in order to identify and eliminate etiological and predisposing factors.
90,000 causes, symptoms and treatment in an article by an ophthalmologist Yu. V. Nezhibovskaya
Date of publication September 14, 2020 Updated April 26, 2021
Definition of the disease. Causes of the disease
Chalazion is a chronic inflammation of the cartilage of the eyelid  . It is accompanied by the appearance of a small pea-shaped formation on the edge of the eyelid, sometimes redness or swelling is observed.It is often mistaken for barley. It is not life threatening and usually does not lead to serious consequences.
Chalazion or Barley?
Few have passed such a nuisance as barley or chalazion for the century. Everyone who has encountered these diseases knows that, despite their small size, they can cause a lot of inconvenience.
To understand how chalazion differs from barley, it is necessary to turn to anatomy.
The structure of the eyelids contains cartilage, which is more pronounced in the upper eyelid.In the thickness of the cartilage are the oblong meibomian glands, which produce a hydrophobic (fatty) component of the tear film. Their ducts open into the inter-marginal space: if you move the lower eyelid, then along the edge you will see small openings of these ducts.
With chronic inflammation of the glands (meibomite), their excretory ducts are blocked. As a result, the contents are collected in the thickness of the eyelid, forming a seal – chalazion (hail)  .
Barley is acute purulent inflammation, which can be localized in the Zeiss gland, eyelash hair follicle (outer barley) or meibomian gland lobules (inner barley).The last type of barley differs clinically only in that the process is concentrated not from the outside, but from the inside of the eyelid  .
In general, chalazion is usually larger and less painful than barley. But one thing can always lead to another: barley can ultimately cause chronic painless chalazion, while chalazion can fester and develop into acute purulent inflammation.
Why there is a chalazion
There is no definite answer to this question.According to some studies, impaired passage of the secretion of the meibomian glands may be associated with diabetes mellitus, stomach or duodenal ulcers, allergic diseases, rosacea, seborrheic dermatitis or hypercholesterolemia (increased blood cholesterol concentration)   19]    . At the same time, it is impossible to argue that it is these diseases that contribute to the emergence of chalazion: they can accompany inflammation of the cartilage of the eyelid, proceeding in parallel.
Chalazion is also associated with acne and chronic blepharitis – a group of diseases accompanied by inflammation of the eyelid margins. Parasitic and infectious diseases include leishmaniasis, tuberculosis and frequent viral infections    .
As a side effect, chalazion may occur in patients receiving Bortezomib (Velcade®) for the treatment of cancer  .
In children, the development of chalazion is sometimes associated with congenital immunodeficiencies (eg, hyperglobulinemia E), as well as viral conjunctivitis and inadequate eyelid hygiene  .
Some doctors hypothesize that chalazion is caused by demodex skin mites. They are present in small quantities on the skin of all people, and their active reproduction and the emergence of demodicosis really accompany the development of chalazion   . But it is impossible to say unequivocally that it is Demodex that causes chalazion, since there are no convincing clinical data  . Most likely, these processes arise due to the same factors that are not fully established and proceed in parallel.
The clinical picture of demodicosis is often observed in elderly patients, as well as in people with weakened immunity, changes in the refractive power of the eye (farsightedness or astigmatism), metabolic disorders, rosacea and seborrhea. The disease can also occur in children with chronic diseases of the lungs and digestive tract, but their role has not yet been proven   .
Do they often get sick with chalazion?
There are no exact epidemiological data on the incidence, but it is known that barley and chalazion are very common diseases.In adults, they are more common than in children – this is associated with the action of androgens on sebum (sebum). However, it should be noted that inflammatory eye diseases in children occupy one of the leading places in the structure of ophthalmological problems in childhood. According to Professor Yu. F. Maychuk, they account for more than 40% of outpatient oculist visits and up to 50% of cases of hospitalization  .
Among the adult population, people 30-50 years old are more susceptible to the disease, both men and women equally   .
If you find similar symptoms, consult your doctor. Do not self-medicate – it is dangerous to your health!
Symptoms of chalazion
The most common complaint of chalazion is a local subcutaneous mass, usually in the upper eyelid region. It is often visible to the naked eye. The size can be as small as a pea, or reach a very significant size.
Chalazion is prone to spontaneous opening and resorption within 2-8 weeks, although in some cases it can disturb the patient for longer than  .With a slow development of inflammation, the chalazion is painless, welded to the underlying layer, but can roll slightly under the fingers, the skin above it is often not inflamed, it can be raised or deformed  . In the case of an acute development of the disease, redness of the skin, swelling and pain appears at the site of the compaction.
The presence of fever and deterioration of the general condition are not characteristic of chalazion. There are no changes in the internal structures of the eye, visual functions, as a rule, do not suffer, but sometimes, as a result of damage to the cornea, astigmatism can be observed  .
Pathogenesis of chalazion
Chalazion is formed as a result of obstruction (blockage) of the meibomian gland. It is a mass of granulation tissue with chronic inflammation (with lipid-saturated lymphocytes and macrophages). Unlike chalazion, barley is primarily acute inflammation , which is associated with necrosis and pus formation.
Due to its structural features, chalazion is otherwise called granuloma. On its histological sections, a deep cutaneous or subcutaneous purulent lipogranulomatous formation surrounded by a pseudocapsule is found.It contains neutrophils, plasma cells, lymphocytes, histiocytes and giant cells that indicate inflammation  .
It is not easy to describe all the mechanisms of the development of a chalazion because of the variety of reasons for its appearance. As a rule, they are associated with impaired microcirculation and the development of inflammation. For example, diabetes mellitus increases blood glucose levels. This condition leads to changes in microcirculation and nutritional problems in the tissues. As a result, the healing process slows down, secondary infections join.
Classification and stages of development of the chalazion
Depending on the depth of the lesion, the chalazion can be superficial (inflammation in the meibomian gland) and deep (inflammation in the cartilage of the eyelid). Clinically, they do not differ in any way.
- large single chalazion;
- chalazion, not amenable to conservative (drug) treatment;
- multiple chalazions  .
Abscessing chalazion – pyogenic granuloma should be included in a separate category.This is an acute process, accompanied by suppuration (abscess formation). It develops due to constant inflammation and infection. At the same time, the chalazion increases, the skin in its area turns red and swells, and touching it causes acute pain.
Complications of chalazion
Large chalazion (the size of large beans or half a century), especially located in the center of the upper eyelid, can cause visual impairment. For example, a mechanical effect on the cornea, which the patient feels like a rolling ball, leads to constant pressure and a change in its shape.As a result of this, astigmatism develops: vision decreases, objects are bifurcated or seem bent, a person begins to confuse letters similar in writing  .
Progressive growth of chalazion can lead to disfigurement of the eyelids: fibrosis of the cartilage followed by inward twisting of the eyelid, the appearance of uneven edges and eyelid baldness (loss of eyelashes)   . If the curvature can be corrected surgically, then it is extremely difficult to restore the correct growth of the eyelashes.
There are also, although quite rare, severe complications of chalazion (for example, preseptal cellulitis – inflammation of the subcutaneous fatty tissue of the orbit). Such complications are mainly observed in patients prone to atopic, non-standard reactions of the body  . Severe pain and lacrimation appear, body temperature rises, vision is noticeably reduced. The skin around the eye becomes red, and the swelling increases. Often, many patients cannot open their eyes on their own.In these cases, medical assistance is required in a hospital setting  .
Diagnostics of the chalazion
A standard ophthalmological examination is quite informative, therefore, additional diagnostic methods are usually not required. The patient must specify the following information:
- whether there are vision problems;
- Whether episodes of acute viral infections have occurred;
- what is the immune status;
- Whether there are chronic diseases, acute skin infections, tuberculosis or oncology;
- whether there were injuries or surgical interventions;
- Whether the patient has been exposed to drugs, toxins, or allergens.
It is possible to carry out an ultrasound examination (ultrasound) of the chalazion for a qualitative assessment of the inflammatory process. This method allows you to clarify its localization, size, structure and relationship with the surrounding tissues. However, in clinical practice, ultrasound of chalazion is not widely used  .
Since the development of chalazion is not associated with bacteria, there is no need to perform bacteriological inoculation. It may be required only if an infection is suspected.It is advisable to conduct a histological examination only in cancer patients with suspicion of tumor metastasis, in all other cases this examination can be considered redundant  .
Differential diagnosis with internal barley is carried out on the basis of inspection. However, during the first two days, these diseases may not differ in any way. Barley can be suspected when body temperature rises, chills and severe inflammation in the eyelid region  .
In elderly people, a group of oncological diseases can be disguised as “endless” (chronic) chalazion: squamous cell carcinoma, seborrheic or microcystic carcinoma. In immunocompromised patients undergoing chemotherapy, the work of the meibomian glands is sometimes disrupted (their secret changes). This leads to the development of meibomite and blepharitis, which contribute to the appearance of chalazion. However, this cannot exclude the possibility of metastasis in the eyelid  . Therefore, the diagnosis of “chalazion” in people with malignant tumors requires increased attention.
Treatment of chalazion
Diseases of the eyelids are most often treated on an outpatient basis. The treatment is quite lengthy (it can take up to several months) and requires patience and careful performance of the procedures from the patient.
In adults, small chalazions dissolve in about two weeks using local combined preparations (with an antibacterial and anti-inflammatory component). At the same time, warm compresses and hygienic massage of the eyelids are prescribed. However, such conservative treatment helps in 50% of cases   .
General (systemic) antibiotic therapy is indicated in the case of primary or secondary infection or in the development of severe purulent inflammation. Also, systemic antibiotic therapy is indicated when chalazion is combined with blepharitis, rosacea or acne  .
There are suggestions that to reduce the risk of recurrence, treatment of chronic blepharitis and chalazion should be carried out in conjunction with a gastroenterologist, under the control of blood glucose levels  . Based on this, doctors recommend eliminating sugar if the patient abuses it, as well as excluding spicy, fatty and fried ones for those who have problems with the work of the gastrointestinal tract.However, this practice does not have a convincing evidence base.
If, in addition to chalazion, the patient is diagnosed with demodicosis, treatment can be aimed at eliminating its cause. With a low number of individuals of skin mites, etiotropic therapy is not carried out   .
If no positive dynamics is observed with conservative treatment, adult patients are prescribed an intralesional steroid injection – an injection of an anti-inflammatory drug into the chalazion under local anesthesia.The steroid reduces the inflammation in the cartilage and the size of the formation, sometimes the chalazion disappears completely. The injection can be used alone or in combination with topical combination drops or ointments.
Intralesional steroid injections are believed to be as effective as surgical treatment of chalazion. However, the introduction of steroids often (in 2% of cases) leads to serious complications: loss of vision, atrophy of subcutaneous fat and skin depigmentation   .
Surgical treatment is actively used. It is carried out with unsuccessful conservative therapy. The operation is simple, performed on an outpatient basis, under local anesthesia. The incision can be made both from the skin side and from the mucosal side. A special fenestrated clamp is applied to the eyelid, the cavity is opened, cleaned, after which an aseptic bandage is applied, and the patient is allowed to go home. He is prescribed local treatment in the form of antibacterial drops or ointment. Sutures are rarely applied.
Bruising may occur after eyelid surgery. It occurs when a clamp is applied, is more often a cosmetic defect and disappears after two weeks. To reduce its size, dry cold compresses are used, but only if, during the diagnosis, the patient does not have a malfunction of the meibomian glands. Otherwise, cold compresses can lead to blockage of the ducts with meibum and the formation of new chalazions.
Due to their age, surgical intervention in children is accompanied by some difficulties, therefore, the operation is often performed in a hospital setting under general anesthesia.
The prognosis is favorable. Relapse is possible if the capsule is incompletely destroyed during the operation, and chalazion in this case may occur in the same place. Often, the re-development of the disease is due to the general condition of the body and other diseases of the eyelids.
To avoid the formation of a chalazion, it is important to follow the basic rules for the care of the eyelids:
- Self-massage of the eyelids to eliminate blockage of the glands.
- Cleansing the eyelids with warm compresses and special cosmetics in the form of a cream or gel.Instead of eyelid hygiene gels, you can use diluted baby shampoo, various soap options. These funds improve the outflow of the secretion of the meibomian glands, cleanse the eyelids from scales and impurities.
- Physiotherapy with LipiFlow for more effective cleansing and passage of the secretions of the meibomian glands. The principle of operation is based on warming up the eyelids (40.5 ° C) and soft pulsation, which stimulates the outflow of secretion from the meibomian glands and their cleansing. Well suited for patients with chronic blepharitis, the complication of which is very often chalazion   .
- The use of foods containing essential unsaturated fatty acids (shellfish, salmon, tuna, herring, fish oil, etc.), or the use of preparations Omega 3 and Omega 9  .
To prevent relapses of chalazion, it is recommended to humidify the air, eat a balanced diet, observe the rules of personal hygiene, massage the eyelids and take care of the skin, choose the right soft contact lenses and observe the mode of wearing them. Also, for the skin of the face and eyelids, adequate sleep, moderate exposure to the sun and protection from ultraviolet radiation, exercise and fresh air are always beneficial.
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