Question of the Week

A 4-year-old girl is brought to the clinic by her mother for a firm, painless right lower eyelid bump that has been present for two weeks. She was started on a course of oral Bactrim by her family physician one week ago, but the bump has not resolved. Her mother denies fever, drainage, recent illness, or history of trauma or insect bites.

What is the most likely underlying pathophysiology for this lesion?

A. Acute staphylococcal infection of the eyelash follicle

B. Obstruction of the meibomian glands

C. Viral infection of the conjunctiva

D. Malignant proliferation of the sebaceous gland cells

Answer

The correct answer is B.

A chalazion is a localized, lipogranulomatous lesion of the eyelid, caused by a blockage of the sebaceous glands of the eyelid, including Meibomian glands and the glands of Zeiss. It presents as a persistent, painless nodule that can increase in size over time. A hordeolum, or a “stye” (choice A), can present similarly, but its underlying pathology results from infection of the tarsal meibomian glands, glands of Moll, or the glands of Zeiss that results in a small abscess. Hordeola typically resolve spontaneously in 1-2 weeks. Conjunctivitis (choice C) usually presents with conjunctival injection and discharge. While swelling may occur, a localized nodule is not typically present. A sebaceous gland carcinoma (choice D) classically presents as a recurrent chalazion unresponsive to treatment, but is unlikely to occur in the pediatric population.

Source: Kuiper J, Vislisel J, Oetting T. Chalazion: Acute presentation and recurrence in a 4-year-old female. EyeRounds.org. August 25, 2014; available from https://eyerounds.org/cases/193-Chalazion.htm