Differentials
Blepharitis
SIGNS / SYMPTOMS
Usually affects the whole eyelid rather than a discrete nodule.
History generally reveals bilateral ocular burning, itching, foreign body sensation, photophobia, crusting on the eyelids, and redness of lid margins. In severe cases, corneal changes can occur, leading to reduced vision.
With associated dry eye syndrome, patients may report sensation of eye dryness.
With associated rosacea, facial erythema, facial telangiectasia, papules, and pustules are seen.
With associated seborrhoeic dermatitis, flaking and greasy skin on the scalp, retro-auricular area, glabella, and nasolabial folds is typical.
Chalazia may be associated with underlying blepharitis.
INVESTIGATIONS
Slit lamp examination is required to confirm the diagnosis and exclude other causes.
In atypical unilateral cases, lid biopsy may be warranted to exclude other disorders, in particular malignancies such as basal cell, squamous cell, or sebaceous cell carcinoma.
Dacryocystitis
SIGNS / SYMPTOMS
There is obstruction and bacterial infection of the lacrimal sac; easily identifiable on examination as a very tender, swollen, and fluctuant mass below the medial epicanthus.
More common in children, typically preceded by a viral upper respiratory tract infection, and commonly associated with constitutional symptoms.
Palpation of the sac may express pus from the lacrimal puncta.
INVESTIGATIONS
If suspected, CT scanning of the face and orbits may be useful to identify inflammation of the lacrimal system and to exclude orbital cellulitis.
Dacryoadenitis
SIGNS / SYMPTOMS
An infection of the lacrimal gland caused by viruses or bacteria; patients usually complain of constitutional symptoms.
Typically presents with pain and swelling at the lateral border of the superior lid, with tearing and discharge from the eye.
INVESTIGATIONS
If suspected, CT scanning of the face and orbits may be useful to identify inflammation of the lacrimal gland and to exclude orbital cellulitis.
Peri-orbital cellulitis
SIGNS / SYMPTOMS
Typically results from secondary bacterial infections as a result of local skin trauma, spread from impetigo, or extension from sinusitis. Sometimes associated with fever. Patients have more diffuse swelling, oedema, and erythema of the lid and peri-orbital region.
INVESTIGATIONS
CT scanning of the face or orbits may be useful to exclude orbital cellulitis.
Orbital cellulitis
SIGNS / SYMPTOMS
Often initially presents with signs and symptoms of peri-orbital cellulitis.
Additionally patients complain of eye pain with movement, decreased vision, fever, and headache.
On examination they may display marked chemosis with proptosis and elevations of intra-ocular pressure.
INVESTIGATIONS
CT scanning is typically performed to identify extension of disease and exclude the potential of abscess formation.
Basal, sebaceous and squamous cell carcinoma
SIGNS / SYMPTOMS
Might be suspected in older patients with lesions of the eyelids that persist.
INVESTIGATIONS
For suspicious lesions, biopsy to exclude carcinoma is warranted.
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