PANCE Blueprint EENT (9%)

Chalazion

Patient will present with → painless granuloma of the internal meibomian sebaceous gland (PAINLESS LID NODULE)

Chalazion are relatively painless lesions (in comparison to a hordeolum which is a "hot", painful lesion).

They are characterized by their insidious onset with minimal irritation. A chalazion is NONINFECTIOUS OBSTRUCTION OF A MEIBOMIAN GLAND causing extravasation of irritating lipid material in the eyelid soft tissues with focal secondary granulomatous inflammation.

Remember: “C” = Chalazion = Chronic and “Cold” (versus hordeolum which is “hot”, acute and not chronic)

Will present as a hard, nontender eyelid swelling, often not very red.

Diagnosis is clinical - Will present as a hard, nontender eyelid swelling, often not very red.

Treat with warm compresses, and eyelid hygiene.  Injection of corticosteroid or incision + curettage may be necessary in large ones affecting vision.

A chalazion is a painless granuloma of the internal meibomian sebaceous gland (PAINLESS LID NODULE)

A chalazion is a painless granuloma of the internal meibomian sebaceous gland (PAINLESS LID NODULE)

Question 1
The best way to differentiate between a Chalazion and a Hordeolum is
A
The presence of pus
Hint:
see answer for explanation
B
hordeolum only appear on the lower eyelid
Hint:
hordeolum may appear on the upper or lower eyelid
C
pain
Hint:
see answer for explanation
D
visual changes
Hint:
neither chalazion or hordeolum should cause visual changes, although if big enough they could partially obstruct the visual field.
E
both A and C
Question 1 Explanation: 
Chalazion are relatively painless lesions (in comparison to a hordeolum which is a "hot", painful lesion). They are characterized by their insidious onset with minimal irritation. A chalazion is noninfectious obstruction of a meibomian gland causing extravasation of irritating lipid material in the eyelid soft tissues with focal secondary granulomatous inflammation. A hordeolum (stye) is an acute, localized swelling of the eyelid that may be external or internal and usually is a pyogenic (typically staphylococcal) infection or abscess.
Question 2
Which of the following is not effective in the treatment of chalazion?
A
Systemic antibiotics
B
Warm compresses
Hint:
See answer
C
Incision and curettage
Hint:
See answer
D
corticosteroid therapy injection
Hint:
See answer
Question 2 Explanation: 
Hot compresses for 5 to 10 min 2 or 3 times a day can be used to hasten resolution of chalazia. Incision and curettage or intrachalazion corticosteroid therapy (0.05 to 0.2 mL triamcinolone 25 mg/mL) may be indicated if chalazia are large, unsightly, and persist for more than several weeks despite conservative therapy. Unlike Hordeolum, chalazion are not infectious and will not benefit from the use of oral antibiotic therapy, unless there is concern for surrounding infection.
Question 3
A patient presents with a nontender, painless, nodule involving a meibomian gland. Which of the following is the most likely diagnosis?
A
Chalazion
B
Dacryocystitis
Hint:
Dacryocystitis is an infection of the lacrimal sac due to obstruction of the nasolacrimal system.
C
Entropion
Hint:
Entropion is an outward turning of the lower lid.
D
Hordeolum
Hint:
A hordeolum is a bacterial inflammation of the base of the eyelash.
Question 3 Explanation: 
Chalazion is characterized by a hard, nontender swelling on the upper or lower lid with redness and swelling of the adjacent conjunctiva and is due to granulomatous inflammation of a meibomian gland.
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