Ophthalmic Emergencies 417
Conditions Affecting the Eyelids
Blepharitis
DIAGNOSIS AND MANAGEMENT
1 Blepharitis is an infection of the eyelid margin, causing red, itchy, crusted
lids, which may become chronic with an allergic element. Styes and
chalazions are commonly associated.
2 Prescribe antibiotic ointment, but refer the patient to the ophthalmology
clinic for follow-up if this condition becomes persistent or recurrent.
Stye (external hordeolum)
DIAGNOSIS AND MANAGEMENT
1 This is due to an infection of a lash follicle pointing on the lid margin.
2 Give the patient antibiotic ointment and remove any protruding eyelash.
Warm bathing may help.
Meibomian abscess (internal hordeolum)
DIAGNOSIS AND MANAGEMENT
1 This is an infected Meibomian gland within the tarsal plate. It does not
discharge as easily as an external stye, and it may leave a residual Meibomian
cyst.
2 Alternatively, it may point and discharge inwards through the tarsal plate,
causing conjunctivitis and discharge.
3 Commence f lucloxacillin 500 mg orally q.d.s. and refer the patient to the
ophthalmology clinic. Warm bathing is unhelpful.
Meibomian cyst (chalazion)
DIAGNOSIS AND MANAGEMENT
1 This feels like a hard pip within the tarsal plate, usually from chronic inf lam-
mation causing granuloma formation.
2 Refer the patient to the ophthalmology clinic for incision and curettage.
Dacryocystitis
DIAGNOSIS AND MANAGEMENT
1 Dacryocystitis is inf lammation of the lacrimal sac in the inner canthus of the
lower eyelid. Dacryoadenitis is inf lammation of the lacrimal gland in the
outer upper eyelid.
