• Users Online: 71
  • Print this page
  • Email this page


 
 
Table of Contents
PROCEDURAL ARTICLE
Year : 2021  |  Volume : 26  |  Issue : 2  |  Page : 80-86

The occasional eyelid lesion


1 School of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
2 Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

Date of Submission14-Aug-2020
Date of Decision16-Nov-2020
Date of Acceptance18-Nov-2020
Date of Web Publication30-Mar-2021

Correspondence Address:
BSc, MD Sarah M Giles
Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON
Canada
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CJRM.CJRM_66_20

Rights and Permissions

How to cite this article:
Crozier M, Giles SM. The occasional eyelid lesion. Can J Rural Med 2021;26:80-6

How to cite this URL:
Crozier M, Giles SM. The occasional eyelid lesion. Can J Rural Med [serial online] 2021 [cited 2021 Apr 19];26:80-6. Available from: https://www.cjrm.ca/text.asp?2021/26/2/80/312614




  Introduction Top


Physicians in the primary and urgent care settings frequently encounter patients presenting with acute inflammatory eyelid nodules and eyelid swelling. The external hordeolum, which is a painful infection involving the eyelid and referred to as a 'stye' in clinical practice, is one of the most common eye/eyelid conditions reported by the general population.[1],[2],[3] There are no known age, sex or demographic differences in the prevalence of external hordeola but patients with chronic conditions such as diabetes, dyslipidaemia and seborrheic dermatitis may be at an increased risk.[4],[5]

Patients with an external hordeolum present with an acute-onset red, painful and swollen abscess along the margin of the eyelid. The condition is often self-limiting, lasting 1–2 weeks and can be treated conservatively. If improperly cared for, or just bad luck, rare cases can progress to preseptal or orbital cellulitis, which may result in hospitalisation and ophthalmic and intracranial complications.[2],[3],[4],[6],[7] Although external hordeola are one of the most common eye/eyelid nodules, there are numerous other eyelid nodules and conditions that should be considered on the differential diagnosis.


  Anatomy/Etiology Top


External hordeola originate from an acute staphylococcal infection of the sebaceous glands (Glands of Zeiss) or modified apocrine glands (Glands of Moll) found along the margin of the upper and lower eyelid.[3],[4] Together, the Glands of Zeiss and Moll produce secretions with antibacterial and immune defence properties.[1],[4],[8] The Glands of Zeis secrete into a duct at the base of the eyelash hair follicle, while the Glands of Moll secrete directly to the eyelid surface next to the base of the eyelashes and anterior to the  Meibomian gland More Detailss.[8] When the glands become blocked, or if stasis occurs, bacterial proliferation and infection can occur. As the infection results in a localised inflammatory response, a purulent and palpable abscess will form along the eyelid margin at the base of the eyelashes.[4] Staphylococcus aureus is the most common bacterial culprit in external hordeolum formation.[3],[9]

It is important to note that an external hordeolum differs from an internal hordeolum, which maintains its name in clinical practice. Internal hordeola arise from the meibomian glands, which are modified sebaceous glands found in the tarsal plate of the eyelids; they are responsible for secreting an oily substance that aids in lubrification of the eyelid.[2],[3],[10] With meibomian gland dysfunction, stasis and subsequent infection with Staphylococcus aureus can also occur. Due to the deeper positioning of the meibomian glands, internal hordeola present with painful swelling within the tarsal plate, and thus, are less defined in their appearance compared to their external counterparts, and they tend to be more painful and longer lasting.[3],[5],[11] Conditions associated with internal hordeola include blepharitis, acne rosacea, trichiasis and cicatricial ectropion.[11],[12],[13]

Chalazia are another form of nodule-forming eyelid lesion that share similarities with hordeola. These non-infectious lesions occur secondary to mechanical obstruction and meibomian gland dysfunction with subsequent stasis and blockage of sebum leading to a lipogranulomatous reaction.[2],[9] A chalazion tends to have an indolent and chronic presentation, and it manifests as a persistent, painless localized nodule within the eyelid or at the eyelid margin [Figure 1].[2],[9]
Figure 1: Eyelid gland anatomy. (a) Orbicularis oculi, (b) Tarsal conjunctiva, (c) Tarsum, (d) Meibomian gland, (e) Gland of Zeis, (f) Gland of Moll, (g) Eyelash. Adapted from McAlinden, González-Andrades, and Skiadaresi[5].

Click here to view



  History, Physical Exam, Diagnosis and Differential Top


The diagnosis of external hordeolum is clinical, so a careful history and physical examination is essential. No diagnostic tests or imaging are required or useful in the diagnosis. Bacterial cultures do not aid in diagnosis, treatment or clinical improvement.[2]

A focused history should determine the duration of symptoms, any prior lesions and any history of foreign body, ocular trauma, decreased vision, fever or pain with ocular movements. Upon examination, the lesion is characterised by acute-onset erythema, swelling and pain near the upper or lower eyelid margin. Along with an external hordeolum, other lesions that should be considered when examining a patient with a nodule on their eyelid are: Internal hordeolum, blepharitis, chalazion, xanthelasma, molluscum contagiosum, eyelid malignancy, pre-septal and orbital cellulitis.


  External Hordeolum Top


The primary symptom of an external hordeolum is localised pain and tenderness on one eyelid; this may be preceded by generalised edema and erythema of the eyelid in some cases.[2],[3],[9] The infection is typically localised and points to the eyelid margin as an inflammatory pustule or papule surrounded by swelling and erythema.[2],[3],[9] The lesion will be tender to palpation and the intensity of pain experienced by the patient will be proportionate to the degree of eyelid swelling.[3] There should not be any pain in ocular movements, and if there is pain with ocular movements, one must be suspicious of ocular cellulitis [Figure 2].
Figure 2: An external hordeolum[14].

Click here to view



  Internal Hordeolum Top


An internal hordeolum typically presents with more diffuse tenderness and erythema. To differentiate an internal hordeolum from an external hordeolum, the patient's eyelid should be everted, so the conjunctival surface can be examined. This can be done by placing a cotton-tipped swab on the outside of the upper lid and gently flipping the lid over the cotton swab.[2],[9] To examine the lower eyelid conjunctival surface, gently grasp the lower eyelid and pull it downwards or ask the patient to do this for you [Figure 3].
Figure 3: Upper eyelid conjunctival surface examination: grasp the patient's eyelid with a gloved hand (using your thumb and index finger), then twist the cotton tip applicator while everting the patient's eyelid. Based on University of Ottawa, Faculty of Medicine[15].

Click here to view


A tender pustule or papule directly on the eyelid margin or on the conjunctival surface indicates an internal hordeolum.[2],[3],[5],[9] In some cases, differentiating between an external and internal hordeolum will not be possible; however, treatment for both infections is generally the same.[2],[9]


  Blepharitis Top


Blepharitis is a related condition which also involves inflammation of the eyelid margin, so it must be considered in the differential diagnosis. Blepharitis is characterised by red and pruritic eyelids, crusting of the eyelids and matting of the eyelashes, conjunctival injection, excessive tearing, photophobia and sometimes flaking of the eyelid skin.[2] In contrast to an external hordeolum, internal hordeolum and a chalazion, blepharitis does not cause a discrete nodule within the eyelid; however, blepharitis can lead to the development of an internal hordeolum, so the two conditions can occur simultaneously [Figure 4].[2],[12]
Figure 4: Blepharitis (magnified view) 16.

Click here to view



  Chalazion, Xanthelasmas and Molluscum Contagiosum Top


A chalazion, as opposed to a hordeolum, has a more sub-acute presentation and manifests with a non-tender nodule with no or mild erythema. Chronic skin changes may be present around the underlying nodule.[2],[4] [Figure 5] illustrates a left eyelid chalazion with mild erythema. Other non-erythematous and non-tender lesions, including xanthelasmas and molluscum contagiosum, can also present on a patient's eyelids. Xanthelasmas are soft, cholesterol filled, yellow plaques that are associated in middle-aged and older adults, and they are typically associated with hypercholesterolemia.[18] [Figure 6] depicts bilateral xanthelasmas. Conversely, molluscum contagiosum is a poxvirus that produces single or multiple small, flesh-coloured papules with a central umbilication; they typically occur in children.[19]
Figure 5: A chalazion[17].

Click here to view
Figure 6: Xanthelasma (bilaterally) 20.

Click here to view



  Eyelid Malignancy Top


Persistent or recurrent painful nodules or masses may suggest a basal cell carcinoma or rarely, an eyelid sebaceous gland carcinoma, keratoacanthoma, squamous cell carcinoma or melanoma.[19] Basal cell carcinomas account for 85%–90% of all eyelid carcinomas; they are firm, slow-growing, painless and indurated lesions.[19],[21],[22] On some occasions, there is associated telangiectasia and eyelash loss.[21],[22] These lesions are most frequently located on the lower eyelid margin, but they can occur elsewhere, including the medial canthus, upper eyelid and lateral canthus.[23] They occur most commonly in fair-skinned individuals with a history of sun exposure, and research suggests they may be associated with basal cell nevus syndrome or xeroderma pigmentosum.[21],[22] Patients with a possible eyelid malignancy should be evaluated with a computed tomography (CT) and punch biopsy, and urgently referred to ophthalmology or plastic surgery.[2]


  Preseptal or Orbital Cellulitis Top


Pain during ocular movements, severe periorbital swelling and erythema, or fever are all red flags for possible preseptal or orbital cellulitis.[24],[25],[26],[27],[28] All patients with red flag symptoms need aggressive and urgent investigations and management, including empiric oral antibiotics for preseptal cellulitis, urgent CT and broad-spectrum intravenous (IV) antibiotics for orbital cellulitis[24],[25],[26],[27],[28] [Figure 7].
Figure 7: Orbital cellulitis[29].

Click here to view


A summary of the above-described eyelid nodules and their respective characteristics is outlined in [Table 1].
Table 1: Overview of the differential diagnosis for an eyelid nodule

Click here to view



  Management Top


The external hordeolum is usually a self-limiting condition as lesions often drain spontaneously within 1–2 weeks. If treatment is required, it is primarily conservative. To facilitate drainage and hasten recovery, clean warm compresses can be applied to the lesion several times a day (for 10 min at least 4 times a day), and a gentle massage with clean hands can be applied to the area.[2],[3],[9],[30] These methods are considered the gold standard for external hordeola management; however, there are no studies confirming their efficacy in shortening the duration of symptoms or improving outcomes.[2] If the clinician is unsure of whether or not the patient has an external or internal hordeolum, massaging should be used with caution, as massaging an internal hordeolum could irritate the cornea.[31]

Lid scrub with saline or baby shampoo that is tear-free and ph-balanced, may promote lesion drainage by clearing debris from clogged glands and removing bacteria by breaking down cell membranes. 12, 32, 33

Topical erythromycin ophthalmic (0.5%) ointment twice daily for 7–10 days can also be considered during treatment to prevent infection of surrounding eyelash follicles and reduce inflammation.[2],[34] This will not alter the course of the external hordeolum and there is minimal evidence demonstrating a benefit from the use of topical antibiotics.[2],[3] Systemic antibiotics are not indicated for external or internal hordeola.[2] Oral antibiotics should only be considered if there is progressively worsening or significant surrounding erythema, signs of bacteraemia, if the patient has tender preauricular lymph nodes, or if there is a concern for progression to preseptal cellulitis.[28],[35],[36],[37]

If the above-mentioned treatment options fail, minor procedural treatments are indicated. Incision and drainage may be performed in cases where the abscess is pointing (a pustule is present).[2],[9] External incisions may lead to scarring, so making an external eyelid incision is inadvisable, unless there is a visible pustule.[9] Incision and drainage of the external hordeola can be performed in the primary care office or emergency department. If the provider is not certain whether or not the lesion is fit for incision and drainage, not confident in their ability to incise and drain the lesion, or if they do not have any experience incising and draining eyelid lesions, referral to an optometrist or ophthalmologist may be appropriate.

Alternatively, if the point of the external hordeolum is at the base of an eyelash forming a furuncle, removal of that one eyelash (epilation of the hair follicle) may promote drainage and healing.[3],[34] Epilation should be performed with caution and only the culprit eyelash should be removed.

Internal hordeola can be treated with the same approach as external hordeola.[11] They often drain spontaneously within 1 to 2 weeks, and the first-line treatment is conservative: a clean warm compress. Lid scrubs and gentle massage with clean hands can also be used with caution to avoid irritating the cornea. Akin to external hordeola management, if conservative treatment fails, incision and drainage may be performed in cases where the abscess is pointing.[10],[11]

Conservative treatment is also the mainstay of chalazion and blepharitis management. Chalazia can typically be managed by the application of clean, warm compresses several times a day, and if necessary, incision and curettage.[2],[38] Conversely, blepharitis can often be managed by good lid hygiene, which includes warm compresses, lid washing and massage and artificial tears. For patients with blepharitis who do not respond to conservative treatment, or for those with severe symptoms, topical or oral antibiotics therapy is recommended. 38,39


  Procedure: External Hordeolum Incision and Drainage Top


Equipment

  • Sterile gloves and saline-soaked swabs
  • 18G needle OR
  • Scalpel handle and #11 blade
  • Chalazion clamp (if available) or a cotton tip applicator
  • Tweezers
  • Gauze
  • Saline-soaked gauze.


Procedure

  • Have the patient lie supine and stand lateral to them on the side of the external hordeolum, so you are comfortable accessing it
  • Inspect the lesion to confirm its size, location, presence of a pustule and that it is an external hordeolum and not an internal hordeolum or chalazion. Rule out the signs of cellulitis during inspection
  • Cleanse the area with saline soaked swabs
  • Use your non-dominant hand to expose the pustule of the external hordeolum. If the external hordeolum is on the eyelid margin, use the chalazion clamp or a cue tip to evert the eyelid to better expose the external hordeolum. Warn the patient of possible discomfort before everting their eyelid
  • Once the external hordeolum's pustule is adequately exposed, ask the patient to remain still and use the point of the needle or scalpel to make a stab incision to the point of the external hordeolum. During the incision, rest the lateral side of your hand on the patient's lateral forehead or cheek to help stabilise your movement. To avoid disrupting eyelash growth do not make an incision directly on the eyelash line
  • Once an incision is made, gently massage the external hordeolum with your gloved index fingers or by using one cotton tip applicator and an index finger to express the abscess. It may be necessary to make an additional incision if no drainage occurs, especially for a larger external hordeolum
  • Gently remove any drained purulent material or blood with a piece of dry gauze
  • Following drainage, provide the patient with saline-soaked gauze and ask them to compress the lesion for 5–10 min.



  Epilation Top


Equipment

  • Tweezers
  • Gauze
  • Saline-soaked gauze.


Procedure

  • Follow steps 1–4 as described above. Ensure the pustule is at the base of an eyelash follicle
  • Once the external hordeolum pustule is adequately exposed, ask the patient to remain still and use the pair of tweezers to remove the culprit eyelash. While doing so, rest the lateral side of your hand on the patient's lateral forehead or cheek to help stabilise your movement. Only remove the one eyelash
  • Follow steps 5–7 as described above.



  Post-Procedure Management Top


Instruct the patient to continue applying a warm compress to the external hordeolum for 10 min at least four times a day until inflammation and swelling resolves. Communicate potential complications (below) with the patient before discharge. Re-evaluate the patient again within 48–72 h to ensure that healing is taking place.[2]


  Complications Top


Potential complications during incision and drainage include bleeding and damage to surrounding structures. The procedure should be performed with caution to avoid inadvertent contact with structures other than the external hordeolum, namely the cornea.

Although uncommon, an untreated or poorly treated external hordeolum (i.e., incomplete drainage) may progress to localised cellulitis on the eyelid or surrounding skin.[2],[4] If the infection is allowed to progress, preseptal or orbital cellulitis can ensue. Mild preseptal cellulitis, which is characterised by swelling and erythema extending beyond the external hordeolum with no signs of systemic toxicity, can usually be managed rapidly in the outpatient setting with empiric oral antibiotics and close follow-up. There is a lack of randomised trials of antibiotic regimens for preseptal cellulitis, but the following combination regimens have been suggested: Trimethoprim-sulfamethoxazole or clindamycin with amoxicillin, amoxicillin-clavulanic acid, cefpodoxime or cefdinir.[40]

Preseptal cellulitis typically demonstrates a quick response with appropriate antibiotic therapy and patients should be re-evaluated in 24–48 h.[34] Unresponsive or worsening preseptal cellulitis and/or signs of more significant infection, including severe swelling and erythema extending beyond the external hordeolum, fever, tender preauricular lymph nodes, painful ocular movements and proptosis warrant re-evaluation[2],[4],[34] Complete blood count with differential and culture may be required, and if there are signs of orbital cellulitis, an orbital CT scan may be needed.[34] In these cases, hospitalisation and prompt treatment with broad-spectrum IV antibiotics are required.[35],[36],[37] The initial antibiotic treatment includes a combination of vancomycin and ceftriaxone or cefotaxime.[40]


  Conclusion Top


Patients with eyelid nodules may present to the emergency department or primary care clinic. The majority of painful nodules will be hordeola that can be managed conservatively with daily intermittent warm compress; however, lid scrubs, antibiotic ointments, incision and drainage or epilation are all options in the management repertoire. If there is any doubt of the diagnosis, the patient should be referred to an optometrist or ophthalmologist. Preseptal or orbital cellulitis should always be considered and managed accordingly during evaluation, diagnosis and treatment.

Financial support and sponsorship Nil.

Conflicts of interest There are no conflicts of interest.



 
  References Top

1.
Pflipsen M, Massaquoi M, Wolf S. Evaluation of the painful eye. Am Fam Physician 2016;93:991-8.  Back to cited text no. 1
    
2.
Willman D, Guier C, Patel B. Stye. Treasure Island, FL, USA: StatPearls Publishing; 2020.  Back to cited text no. 2
    
3.
Olson MD. The common stye. J Sch Health 1991;61:95-7.  Back to cited text no. 3
    
4.
Bragg KJ, Le PH, Le JK. Hordeolum. Treasure Island, FL, USA: StatPearls Publishing; 2020  Back to cited text no. 4
    
5.
McAlinden C, González-Andrades M, Skiadaresi E. Hordeolum: Acute abscess within an eyelid sebaceous gland. Cleve Clin J Med 2016;83:332-4.  Back to cited text no. 5
    
6.
Chaudhry IA, Shamsi FA, Elzaridi E, Al-Rashed W, Al-Amri A, Al-Anezi F, et al. Outcome of treated orbital cellulitis in a tertiary eye care center in the middle East. Ophthalmology 2007;114:345-54.  Back to cited text no. 6
    
7.
Goytia VK, Giannoni CM, Edwards MS. Intraorbital and intracranial extension of sinusitis: Comparative morbidity. J Pediatr 2011;158:486-91.  Back to cited text no. 7
    
8.
Takahashi Y, Watanabe A, Matsuda H, Nakamura Y, Nakano T, Asamoto K, et al. Anatomy of secretory glands in the eyelid and conjunctiva: A photographic review. Ophthalmic Plast Reconstr Surg 2013;29:215-9.  Back to cited text no. 8
    
9.
Wald ER. Periorbital and orbital infections. Pediatr Rev 2004;25:312-20.  Back to cited text no. 9
    
10.
Lindsley K, Nichols JJ, Dickersin K. Non-surgical interventions for acute internal hordeolum. Cochrane Database Syst Rev 2017;1:CD007742.  Back to cited text no. 10
    
11.
Lindsley K, Nichols JJ, Dickersin K. Interventions for acute internal hordeolum. Cochrane Database Syst Rev 2010;1:CD007742.  Back to cited text no. 11
    
12.
Skorin L. Hordeolum and chalazion treatment: The full gamut. Optom Today 2002:25-7.  Back to cited text no. 12
    
13.
Moriarty P, Collin J. Eyelid problems. Practioner 1982;226:901-23.  Back to cited text no. 13
    
14.
External Hordeolum. Wikimedia Commons; 2017. Available from: https://commons.wikimedia.org/wiki/File:External_hordeolum.jpg#filelinks. [Last accessed on 2020 Nov 13].  Back to cited text no. 14
    
15.
Clinical Techniques: Eyelid Eversion. University of Ottawa Faculty of Medicine; 2005.Available from: https://www.med.uottawa.ca/procedures/slamp/eversion.htm. [Last accessed on 2020 Jun 25].  Back to cited text no. 15
    
16.
Blepharitis. Wikimedia Commons; 2017. Available from: https://commons.wikimedia.org/wiki/File:Anterior_Blepharitis.jpg. [Last accessed on 2020 Nov 13].  Back to cited text no. 16
    
17.
Chalazion. Wikimedia Commons; 2007. Available from: https://commons.wikimedia.org/wiki/File:Chalazion.JPG. [Last accessed on 2020 Nov 13].  Back to cited text no. 17
    
18.
Bergman R. The pathogenesis and clinical significance of xanthelasma palpebrarum. J Am Acad Dermatol 1994;30:236-42.  Back to cited text no. 18
    
19.
Ghosh C, Ghosh T. Eyelid Lesions. UpToDate; 2020. Available from: https://www.uptodate.com/contents/eyelid-lesions. [Last accessed on 2020 Aug 05].  Back to cited text no. 19
    
20.
Xanthelasma. Wikimedia Commons; 2012. Available from: https://commons.wikimedia.org/wiki/File:Eyelid_Xanthelasma.jpg. [Last accessed on 2020 Nov 13].  Back to cited text no. 20
    
21.
Margo CE, Waltz K. Basal cell carcinoma of the eyelid and periocular skin. Surv Ophthalmol 1993;38:169-92.  Back to cited text no. 21
    
22.
Cook BE Jr., Bartley GB. Epidemiologic characteristics and clinical course of patients with malignant eyelid tumors in an incidence cohort in Olmsted County, Minnesota. Ophthalmology 1999;106:746-50.  Back to cited text no. 22
    
23.
Doxanas MT, Green WR, Iliff CE. Factors in the successful surgical management of basal cell carcinoma of the eyelids. Am J Ophthalmol 1981;91:726-36.  Back to cited text no. 23
    
24.
Botting AM, McIntosh D, Mahadevan M. Paediatric pre- and post-septal peri-orbital infections are different diseases. A retrospective review of 262 cases. Int J Pediatr Otorhinolaryngol 2008;72:377-83.  Back to cited text no. 24
    
25.
Rudloe TF, Harper MB, Prabhu SP, Rahbar R, Vanderveen D, Kimia AA. Acute periorbital infections: Who needs emergent imaging? Pediatrics 2010;125:e719-26.  Back to cited text no. 25
    
26.
Patt BS, Manning SC. Blindness resulting from orbital complications of sinusitis. Otolaryngol Head Neck Surg 1991;104:789-95.  Back to cited text no. 26
    
27.
Lee S, Yen MT. Management of preseptal and orbital cellulitis. Saudi J Ophthalmol 2011;25:21-9.  Back to cited text no. 27
    
28.
Howe L, Jones NS. Guidelines for the management of periorbital cellulitis/abscess. Clin Otolaryngol Allied Sci 2004;29:725-8.  Back to cited text no. 28
    
29.
Sellers TF. Orbital Cellulitis. CDC Public Health Image Library; 1963. Available from: https://phil.cdc.gov/Details.aspx?pid=2843. [Last accessed on 2020 Nov 13].  Back to cited text no. 29
    
30.
Marchick M. Eye issues. In: Primary Care for Emergency Physicians. New York: Springer International Publishing; 2016. p. 15-30.  Back to cited text no. 30
    
31.
McMonnies CW, Korb DR, Blackie CA. The role of heat in rubbing and massage-related corneal deformation. Cont Lens Anterior Eye 2012;35:148-54.  Back to cited text no. 31
    
32.
Driver PJ, Lemp MA. Meibomian gland dysfunction. Surv Ophthalmol 1996;40:343-67.  Back to cited text no. 32
    
33.
McCulley JP. Blepharoconjunctivitis. Int Ophthalmol Clin 1984;24:65-77.  Back to cited text no. 33
    
34.
Walker R, Adhikari S. Eye emergencies. In: Tintinilli JE, Stapczynski S, Ma J, Yealy DM, Meckler GD, Cline DM, editors. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York: McGraw-Hill; 2016.  Back to cited text no. 34
    
35.
Nageswaran S, Woods CR, Benjamin DK Jr, Givner LB, Shetty AK. Orbital cellulitis in children. Pediatr Infect Dis J 2006;25:695-9.  Back to cited text no. 35
    
36.
Mahalingam-Dhingra A, Lander L, Preciado DA, Taylormoore J, Shah RK. Orbital and periorbital infections: A national perspective. Arch Otolaryngol Head Neck Surg 2011;137:769-73.  Back to cited text no. 36
    
37.
Schwartz G. Etiology, diagnosis, and treatment of orbital infections. Curr Infect Dis Rep 2002;4:201-5.  Back to cited text no. 37
    
38.
Lindsley K, Matsumura S, Hatef E, Akpek EK. Interventions for chronic blepharitis. Cochrane Database Syst Rev 2012;2012:CD005556.  Back to cited text no. 38
    
39.
Wladis EJ, Bradley EA, Bilyk JR, Yen MT, Mawn LA. Oral antibiotics for meibomian gland-related ocular surface disease: A report by the American Academy of Ophthalmology. Ophthalmology 2016;123:492-6.  Back to cited text no. 39
    
40.
Gappy C, Archer S, Barza M. Orbital Cellulitis. UpToDate; 2020. Available from: https://www.uptodate.com/contents/orbital-cellulitis. [Last accessed on 2020 Aug 05].  Back to cited text no. 40
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
  Introduction
  Anatomy/Etiology
   History, Physica...
  External Hordeolum
  Internal Hordeolum
  Blepharitis
   Chalazion, Xanth...
  Eyelid Malignancy
   Preseptal or Orb...
  Management
   Procedure: Exter...
  Epilation
   Post-Procedure M...
  Complications
  Conclusion
   References
   Article Figures
   Article Tables

 Article Access Statistics
    Viewed262    
    Printed0    
    Emailed0    
    PDF Downloaded32    
    Comments [Add]    

Recommend this journal