Tuesday, August 4, 2015

Eyelid cysts a.k.a. chalazia or styes

Most of the time, cysts of the eyelids or ‘bak chiam’ (in Hokkien) are caused by blockages of the oil glands inside the eyelids. When the openings of these glands are blocked, the oil produced by the gland cannot be released, and it builds up to form a lump in the eyelid.
The white dots are blocked oil gland openings
Oil collects inside the blocked gland, causing a lump to form

Commonly, it feels like a little pea, which can be painful if it gets infected. These cysts are also called ‘chalazion’, and they are very common. They can be associated with inflammation of the eyelids called ‘blepharitis’. Normally, most chalazia are not serious and many do go away on their own with time. Big ones near the middle of the upper eyelid can cause blurring of vision by pressing on the cornea/window of the eyeball.

Problems with these cysts arise especially when they do not go away after a long time, or if they keep coming back. Big cysts that do not resolve on their own are easily treated with a 5 minute office procedure to drain the oil from the blocked oil gland.

Cysts usually happen individually, and then disappear for long periods of time. On the other hand, a smaller proportion of people get cysts that go away and then come back, often in another eyelid or even on the other side. Recurrent cysts are usually associated with ongoing eyelid inflammation. For many people, hot compresses at night followed by eyelid cleaning (perhaps with products such as Lid Care/Blephagel) are helpful in reducing the chances of recurrence.

Very stubborn cases may be related to changes in the eyelid oil to a very thicky waxy material which blocks the channels of the glands. It is thought that these changes are related to the type of bacteria living on the skin of that person, which can also change the normal oil to other irritating substances.

Treating chalazia

The simplest measure recommended is hot compresses, with which we hope to make the oil more liquid and to flow out better.

It has been found that long courses of certain antibiotics from 1 month to several months help to resolve many of these blepharitis cases. Besides their antibacterial action, antibiotics in the tetracycline class also have anti-inflammatory properties. Besides antibiotics, taking Omega 3 oils in the diet or via supplements also helps to reduce the thickness of the eyelid oils and to reduce inflammation in the body.

Oil in some of the glands has turned into a thick material like toothpaste. In some other glands, the oil remains liquid and comes out as little droplets.
Recently, it has also been reported that some people have an overgrowth of skin mites in the eyelids. An article in the American Journal of Ophthalmology (Am J Ophthalmol. 2014 Feb;157(2):342-348) found that more patients with chalazia had these mites, and that patients found to have these mites had a higher chance of cyst recurrence. I routinely check for the presence of these mites in patients with inflammatory eyelid problems, and start treatment against them if necessary.

Pulling gently on the eyelashes causes the white tails of the mites to poke out. They can be teased out onto the eyelid surface and then scooped up with forceps.

One mite having a stroll across the microscope slide...

If despite simple measures the cysts persist, then a simple incision and drainage procedure can be performed in clinic. This usually take 5 minutes or less, after which the eye is padded for 2-3 hours.

Can these cysts be anything more dangerous? Very rarely, yes. There is a rare oil gland tumour that can present like a cyst. If a cyst keeps recurring in the same place, and especially if it is gradually getting bigger or associated with adjacent loss of eyelashes, the doctor should consider taking a specimen and sending it to the laboratory for further examination. But this is a rare condition and is unlikely if the recurrent cysts are happening in different places.


To summarise, do consult an eye specialist, as sometimes prescription medicines like antibiotics or other treatments may help. Dietary changes like taking more Omega 3 oils also would be good, and in the meantime continue with hot compresses and keeping the eyelids clean.

20 comments:

  1. This comment has been removed by a blog administrator.

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  2. Give some suggestion to overcome this disease.
    dottor carlo orione

    ReplyDelete
  3. Hello doctor,

    Is this condition contagious if it's a matter of the gland being blocked by oil.

    ReplyDelete
    Replies
    1. No, fortunately it is not contagious.

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  4. Thank you so much doctor for your response.

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  5. Hello Dr Por,

    I read that there are two wipes, Blephadex and Cliradex which are useful for blepharitis as they contain tea tree oil.

    Are these wipes available in your clinic?

    Thank you!

    ReplyDelete
  6. Hi Jo, we do have Cliradex wipes in our clinic. They work fine as a general cleanser, but I have not found them to be effective against Demodex mites.

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    1. Hi Dr Por, which wipes or methods is useful for demodex?

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    2. I generally use a compunded topical Ivermectin 1% cream to eradicate demodex. Commercially, Soolantra is available but it is specified as not being for ophthalmic use.

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  7. Hi Dr Por,

    Soolantra is able to apply on lid lash?

    I went to a few Doctors but then through the microscope, they mentioned that I do not have demodex. I'm not sure if they checked thoroughly as the mites may be inside The Eyelash?

    Ive also started using theratears

    ReplyDelete
    Replies
    1. I've also started using Thera tears sterilid cleansers and going to start on thera tears eye supplement. I'm wondering if the eyes will get used to the eyelid cleanser after a while? Or I should change eye products after a few months to prevent my she's from getting used to it.

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    2. Hi, sorry for late reply. I hope you are feeling better by now. But generally speaking, I don't think it is essential to keep changing your eye care products.

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  8. I had chalazion surgery last week. The chalazion has nearly gone, but will fill and drain, when I massage.

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    Replies
    1. Yes, that sometimes happens. It should stop filling within the next week or so. If it continues you should get your doctor to check it again.

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  9. I went back to the surgeon as the chalazion continues to fill and drain. He said warm compresses 4 to 5 times a day, and that I have scar tissue from surgery. Will this tend to resolve over time?

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    Replies
    1. Hi, it's a bit unusual to still be doing this, but you should follow your doctor's advice with regard to the problem. I'm not sure if anyone can say more about your particular situation unless they actually have a look and examine your eye...If it really disturbs you, you could consider a second opinion.

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  10. Hi Dr Pok,
    I'm having a bad case of stye/chalazion right now.. And it's swelling and draining.. My normal doc gave me a cream and 2 types of antibiotics.. Would u suggest I go for the lancing straight? How much would the procedure cost?

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    1. Hi Baofa, if it is already draining, it is usually starting to get better. I would carry on with the cream and antibiotics. If there is a persistent lump and nothing is coming out, then a drainage procedure might be appropriate. Please call the respective clinic to clarify the costs of such a procedure.

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