Eye Started Crying I: Periorbital and Eyelid Infections

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During a slow night in Fast Track, you decide to rewatch all 6 seasons of Dawson’s Creek. You start to tear up all over again when Joey chooses Pacey over Dawson. It’s just not fair! As you reach over for your snuggie and a box of tissues, you realize that your right eye actually kind of hurts… Maybe it’s time to head over to Kings County for a check-up and review of common (non-deadly) eye complaints. We’ll start with areas outside the eye for now. Name the diagnosis and the treatment:

Hordeolum

I noticed a lump on my eyelid about 2 days ago. It's red, itchy, and painful. I noticed some pus yesterday

Hordeolum (stye): A localized infection usually involving eyelash hair follicles (external) or meibomian glands (internal). It is most commonly caused by Staphylococcal organisms.
Treatment: Usually only requires warm compresses. Topical erythromycin or bacitracin may be used.

Hey doc, this stye you diagnosed me with 2 weeks ago? I feel better but the lump isn't going away. It doesn't hurt anymore. But this lump is hard.

Chalazion: A localized area of chronic inflammation and swelling caused by blockage of gland. A hordeolum can lead to chalazion formation. They are usually aseptic.
Treatment: There are no antibiotics required. Warm compresses, lid massages, and steroid eye drops may be used.

Blepharitis-6

My eyelid has been itchy and painful. I feel like it's crusted constantly. There's no bump or anything, but whole eyelid is red and a little swollen.

Blepharitis: An inflammatory condition of the eyelid, usually chronic but with acute exacerbations. It is caused by Staphylococcal organisms.
Treatment: It can be difficult to treat but usually consists of lid hygiene, warm compresses, and short/long term topical antibiotics.

preseptal

My eyes been bothering me for about 2 days now. The area around is red and a little swollen. I feel like my eye is a little red too. I haven't had any fevers though, and it doesn't hurt when I move my eyes. My vision hasn't changed.

Preseptal Cellulitis: An inflammation around the eyelid and surrounding soft tissue anterior to the orbital septum.
Treatment: It is important to aggressively treat pre-orbital cellulitis to prevent complications. Treatment is started with amoxicilling/sulbactam (outpatient) or ceftriaxone (inpatient). A second or third generation cephalosporin is appropriate for initial treatment

What is the orbital septum and why is it important?

septal

The orbital septum is a fascial membrane that acts as a boundary in the eye. Superiorly, it blends with the tendon of the palpebrae superioris to the superior orbital margin. Inferiorly, it blends with the tarsal bone to the inferior orbital membrane.

The orbital septum is important for keeping infections from spreading posteriorly. If infection spreads posteriorly, it is called orbital cellulitis. Complications from orbital cellulitis include blindness, meningitis, and brain abscesses.

References:
Deschênes, Jean. Chalazion. Medscape.
Ehrenhaus, Michael P. Hordeolum. Medscape.
Kwitko, Geoffrey.Preseptal Cellulitis. Medscape.
Lowery, R Scott. Adult Blepharitis. Medscape.

Remember, what is evidence-based and what we do in practice may not always be the right answer on the exam. Frustrating, I know, but don’t cry about it.