There are several glands associated with the eyelids. The meibomian glands are within the firm part of the eyelid called the tarsus. They open along the back edge of the lid, releasing oily sebaceous secretions; these form the important oily surface layer of the tear film. You know the effect that oil has on water, making a smooth surface; this is exactly what happens with the tear film. The oil stabilises the tear film and prevents the evaporation of tears. When there is a disorder of these glands, (See under blepharitis), the openings of the glands along the lid margin become obstructed. This leads to the accumulation of secretions and causes inflammation. When there is total obstruction, a cyst of pus-like material forms. This is a chalazion. It is unsightly and uncomfortable.
The chalazion is usually visible externally, but can be seen internally when the lid is everted
as seen on the right. Drainage can be performed from the inner surface,so that there
will not be a visible scar.
- Chalazia may settle, or discharge spontaneously. Sometimes, unfortunately, they do neither and just grumble on. It is under these circumstances that the cyst needs to be drained surgically. A local anaesthetic is given. The lid is turned and a small cut is made on the inner surface. The contents of the cyst are curetted out. The lid is then padded with antibiotic ointment for couple of hours. There will be a little swelling and bruising, which will settle after a couple of days. The underlying blepharitis needs to be addressed with lid hygiene, and sometimes an antibiotic tablet such as doxycycline. Sometimes grumbling inflammation associated with a chalazion can be treated with a steroid injection.
- A Stye is an inflamed lash follicle. Generally by pulling the eyelash and applying hot compresses, the pus drains and it all settles down. Rarely does it have to be drained surgically.
- A Sudoriferous cyst is a clear sweat filled cyst that occurs along the lid margin. It does not get red and inflamed. It can often be drained with a fine needle. Firm pressure over the area often prevents recurrence. If it does recur it is best de-roofed with a local anaesthetic.