External: Infection of eyelash follicle or glands (Zeis/Moll)
Internal: Meibomian gland infection
Features: Red, tender, painful swelling near lid margin
Treatment:
- Warm compress 2–4x daily (resolve in ~1 month)
- Avoid squeezing (prevents spread)
- Persistent/large → I&D (ophthalmology referral)
- Recurrent → assess for blepharitis/meibomian dysfunction

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Chalazion (Meibomian Cyst)

Features: Firm, painless, slow-growing lump (blocked meibomian gland)
Treatment:
- Warm compress 2–4x daily (1 month)
- Persistent → I&C or steroid injection (ophthalmology)
- Recurrent → assess for rosacea/blepharitis

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Blepharitis

Types:
- Anterior: Affects eyelid margins/eyelashes (crusting/scales)
- Posterior: Affects meibomian glands (blocked glands, foamy tears)
Associations: Staphylococcal infection, seborrhoea, rosacea, allergy
Treatment:
- General:
  - Warm compress 2–4x daily
  - Eyelid hygiene (proprietary cleansers; avoid baby shampoo)
  - Lubricating eye drops
- Anterior: Chloramphenicol 1% ointment OD (if bacterial)
- Posterior:
  - Doxycycline 100 mg OD (4–8 weeks, reduce to 50 mg)
  - Topical azithromycin if severe (doxycycline contraindicated)
  - Firm eyelid massage (express blocked oils)
NB: Address underlying rosacea/seborrhoea to prevent recurrence
Complications: Keratitis, chalazion, dry eye syndrome

Stye (Hordeolum), Chalazion (Meibomian Cyst), and Blepharitis

Stye (Hordeolum)

Definition

Features

Management

Warm Compresses 2–4× daily for ~10–15 minutes; usually resolves within ~1 month.
Avoid Squeezing: Prevents spread of infection or scarring.
Persistent or Large: Incision & drainage (ophthalmology referral).
Recurrent: Assess for underlying blepharitis or meibomian gland dysfunction.

Chalazion (Meibomian Cyst)

Definition

Features

Management

Warm Compresses 2–4× daily for ~1 month to aid drainage.
Persistent Chalazion: Incision & curettage or steroid injection by ophthalmology.
Recurrent: Evaluate for rosacea or chronic blepharitis.

Blepharitis

Definition

Inflammation of the eyelid margins, affecting eyelashes (anterior) or meibomian glands (posterior).

Types & Associations

Anterior Blepharitis
- Involves eyelid margin/eyelashes (crusting/scales).
- Often staphylococcal or seborrhoeic.
Posterior Blepharitis
- Meibomian gland dysfunction (blocked glands, foamy tears).
- Linked to rosacea or allergy.

Management

General Measures
- Warm Compresses 2–4× daily → helps express blocked glands.
- Eyelid Hygiene: Use proprietary lid cleansers (avoid baby shampoo if possible).
- Lubricating Eye Drops: Relieve dryness.
Anterior Blepharitis (If bacterial)
- Chloramphenicol 1% ointment once daily at night.
Posterior Blepharitis
- Doxycycline 100 mg daily for 4–8 weeks (reduce to 50 mg if improved).
- Topical azithromycin if severe (contraindication to doxy).
- Firm Eyelid Massage to express oils from meibomian glands.
Address underlying rosacea or seborrhoea to reduce recurrence.