How to tell the difference between "chalazion" and "stye"

Optometrists often encounter a pimple-like pimple around the eyelid margin of a patient in their work. We know that the patient may have a stye or a chalazion. However, many people have difficulty distinguishing between the two diseases. So, how to tell the difference between a stye and a chalazion? one. Stye, medically called hordeolum, is caused by bacterial infection of the eyelid gland glands and is relatively common. Hordeolum is divided into inner hordeolum and outer hordeolum. Internal hordeolum is an infection of the meibomian glands, also known as internal stye, mostly caused by Staphylococcus, especially Staphylococcus aureus, infecting the eyelid glands. External hordeolum is an infection of eyelash hair follicles or their attached sebaceous glands and abnormal sweat glands, also known as external stye. 【Clinical manifestations】The affected area has the manifestations of acute inflammation such as redness, swelling, heat and pain. The inflammatory reaction of external hordeolum is mainly located at the eyelid margin at the root of the eyelashes. The redness and swelling of the eyelid is relatively diffuse at the beginning, but induration and tenderness can be found on palpation; when it is adjacent to the lateral canthal angle, the pain is particularly obvious, and it can also cause reactive bulbs. Conjunctival edema. There may be ipsilateral preauricular lymphadenopathy and tenderness. After a few days, the induration becomes softened pus, the pus head is at the root of the eyelashes, and finally bursts. After the pus is discharged, the redness and swelling subside quickly, the pain is relieved, and gradually subsided. In children, the elderly, or those with chronic wasting diseases such as diabetes, hordeolum can spread in the subcutaneous tissue of the eyelid and develop into eyelid cellulitis. At this time, the entire eyelid is red and swollen, which can spread to the ipsilateral face. The eyelid cannot be opened, the touch is hard, the tenderness is obvious, and the reactive edema of the bulbar conjunctiva is severe, which can be exposed outside the palpebral fissure. It may be accompanied by systemic symptoms such as fever, chills, and headache. 【Diagnosis】It is easy to diagnose according to clinical manifestations. Bacterial cultures are rarely required to identify causative bacteria. After completion, it should be incised to drain the pus. The incision for external hordeolum should be on the skin surface, parallel to the eyelid margin, so that it is consistent with the eyelid dermis to reduce scarring. If the abscess is large, a drain can be placed. The incision for internal hordeolum is often on the tarsal conjunctiva, perpendicular to the palpebral margin, to avoid injury to the meibomian ducts. When the abscess has not yet formed, it should not be incised, and it should not be squeezed to drain the pus. Otherwise, because the eyelid and facial veins have no valves, the infection will spread, resulting in eyelid cellulitis, even cavernous sinus sepsis or sepsis, which is life-threatening. Once this happens, a sufficient amount of broad-spectrum antibiotics mainly to inhibit Staphylococcus aureus should be used as soon as possible, and bacterial culture and drug sensitivity test should be performed on pus or blood to treat early hordeolum. 10 to 15 minutes each time, 3 to 4 times a day, in order to promote the blood circulation of the eyelids, promote the softening of induration, relieve symptoms, and promote the dissipation of inflammation. Drop antibiotic eye drops 4 to 6 times a day to control infection. When the abscess is shaped, more sensitive antibiotics are selected and treated according to the principles of sepsis treatment.

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two. Chalazion Meibomian gland cyst, also known as chalazion, is an idiopathic aseptic chronic granulomatous inflammation caused by the obstruction of the gland discharge duct, resulting in the retention of gland secretions. [Clinical manifestations] It is more common in adolescents or middle-aged people, which may be related to the strong secretion function of the meibomian glands. It manifests as a round mass under the eyelid, which can occur singly or alternately. Size is not ー, progress is slow. There is generally no pain, and the mass is not markedly tender. Small cysts can only be detected by careful palpation. Larger ones can make the skin bulge, but have no adhesion to the skin. The palpebral conjunctival surface corresponding to the mass was a purplish red or gray-red lesion. Small cysts can be absorbed by themselves, but most remain unchanged for a long time, or gradually grow up and become soft in texture. It can also rupture on its own, expel colloid-like contents, form granulomas on the palpebral conjunctiva, or form dark purple-red granulation tissue under the skin. If there is secondary infection, when acute suppurative inflammation is formed, the clinical manifestations are the same as those of internal hordeolum. 【Diagnosis】According to the patient's absence of obvious pain and eyelid induration, the diagnosis can be made. For recurrent or elderly meibomian cysts, the excised material should be subjected to pathological examination to exclude meibomian adenocarcinoma. 【Treatment】Small and asymptomatic meibomian gland cysts do not require treatment and are left to be absorbed on their own. Larger ones can be treated with hot compresses. If it does not subside, it should be surgically removed under local anesthesia. After clamping the eyelid of the cyst with meibomian gland cyst forceps, make an incision perpendicular to the palpebral conjunctiva on the tarsal conjunctiva, cut the palpebral conjunctiva, scrape off the cyst contents, and gradually peel off the cyst wall by separating the cysts on both sides. Complete extraction. All in all, the difference between stye and chalazion is still relatively large, and the optometrist should correctly distinguish stye and chalazion.