Eyelid swelling: chalazion vs hordoleum

[WhistlePig]

This is a question about my daughter's eye. A lump on her eyelid appeared several months ago which I figured to be a chalazion or a sty after much internet research. I tried to put warm compresses on it (which isn't easy with a toddler--she's 22 months old) and it finally went away. Now it's back, and has been back for the last couple of months. I took her to both the peditrician and a regular eye doctor (optometrist) who both shrugged and said to apply warm compresses. I've done my best to apply them (but it's very difficult) and it's just getting worse. How long should I wait until I seek out an opthalmologist and will they be able to do anything? Is there anything else I can do?

Thanks Dr. Steve.

[Dr Steve]

This is a question about my daughter's eye. A lump on her eyelid appeared several months ago which I figured to be a chalazion or a sty after much internet research. I tried to put warm compresses on it (which isn't easy with a toddler--she's 22 months old) and it finally went away. Now it's back, and has been back for the last couple of months. I took her to both the peditrician and a regular eye doctor (optometrist) who both shrugged and said to apply warm compresses. I've done my best to apply them (but it's very difficult) and it's just getting worse. How long should I wait until I seek out an opthalmologist and will they be able to do anything? Is there anything else I can do?

Thanks Dr. Steve.

There are two common kinds of lumps on the eyelid in kids, the chalazion or the hordoleum (stye). The hordoleum (we have a different word for EVERYTHING) is caused by an infected oil gland in the eyelid, and generally appears at the edge of the eyelid. A chalazion is an accumulation of material in the eyelid as a result of a blocked oil gland.

They'll usually go away with warm compresses after a few weeks, but in some refractory cases, they need to be removed surgically. In adults, they flip the eyelid inside out, inject some numbing medicine (lidocaine) into the eyelid, and scoop it out. You can imagine in a kid this is not an acceptable route. Children usually require sedation, with all the risks that go with that.

If it's getting worse after several months and the compresses aren't helping, a good pediatric ophthalmologist (if you have one in your area) would be able to help you. If you don't have a pediatric ophth, ask around who does the best job with children.

My theory is that these things occur due to allergies...the ophthalmologist may give you some eyelid wash and/or some allergy eye drops to use during allergy season to prevent this from happening again.

good luck and let us know how everything turns out!


your friend,



steve

[WhistlePig]

Thanks for the advice. I'm calling a pediatric opthalmologist this week--will let you know what they say.

[WhistlePig]

Saw the pediatric opthalmologist yesterday. Very disheartening. First, he wasn't very personable. He barely looked at my daughter's eye and said I had two options: continue with the warm compresses, 4-6 times a day for 15 minutes each time and hope scar tissue doesn't form (or else the lump will be there forever) or surgery. I really hate the thought of my kid going under the knife, but then this warm compress deal is impossible. Even if my husband holds her down and I put the compress on her eye she thrashes around and cries and we can only do it for a couple of minutes, max. The top of her eyelid now looks raw, probably from the thrashing and rubbing against the compress and I hate to even try now.

Is it extremely risky for a 2 year old to go under anesthesia? I'm so scared!

[Thebazile78]

Saw the pediatric opthalmologist yesterday. Very disheartening. First, he wasn't very personable. He barely looked at my daughter's eye and said I had two options: continue with the warm compresses, 4-6 times a day for 15 minutes each time and hope scar tissue doesn't form (or else the lump will be there forever) or surgery. I really hate the thought of my kid going under the knife, but then this warm compress deal is impossible. Even if my husband holds her down and I put the compress on her eye she thrashes around and cries and we can only do it for a couple of minutes, max. The top of her eyelid now looks raw, probably from the thrashing and rubbing against the compress and I hate to even try now.

Is it extremely risky for a 2 year old to go under anesthesia? I'm so scared!

Does your daughter have any other medical issues that might be problematic?

They put babies under all the time. There are even pediatric anesthesiologists because children's bodies react differently to medications than adults' bodies. (Really. Kids are not just miniature adults in these cases.)

Talk to your pediatrician for more advice, though. (Also, if there's another opthalmalogist, even if they're not primarily for Ped's, take her there for a second opinion. Ours was a gem, but since he's probably no longer in practice and would be in northern NJ if he were, it's of no use to you.)

[WhistlePig]

Does your daughter have any other medical issues that might be problematic?

They put babies under all the time. There are even pediatric anesthesiologists because children's bodies react differently to medications than adults' bodies. (Really. Kids are not just miniature adults in these cases.)

Talk to your pediatrician for more advice, though. (Also, if there's another opthalmalogist, even if they're not primarily for Ped's, take her there for a second opinion. Ours was a gem, but since he's probably no longer in practice and would be in northern NJ if he were, it's of no use to you.)

No, no other medical issues. I think I will get a second opinion.
The good thing is this surgery only takes about 5 minutes.
Thanks for the suggestion!

[Dr Steve]

No, no other medical issues. I think I will get a second opinion.
The good thing is this surgery only takes about 5 minutes.
Thanks for the suggestion!


sorry I missed your follow up post. sometimes the system doesn't highlight the new posts for me. weird.

anyway, I've had this surgery done myself about a dozen times; never had any problem with scar tissue myself. When they do it to me, they just flip my eyelid and start sticking needles into the underside. Most unpleasant, and no child could realistically stand it, therefore anaesthesia is required. it'd be about the same level as putting in myringotomy tubes (ear drum tubes for ear infections) and you're right, the surgery is very quick.

good luck and let us know how it turns out!


steve

[WhistlePig]

Do you think this thing will keep coming back, then? I mean, once you have one are you doomed to keep getting them for life? Why do they keep recurring for you, Dr. Steve?

[Dr Steve]

Do you think this thing will keep coming back, then? I mean, once you have one are you doomed to keep getting them for life? Why do they keep recurring for you, Dr. Steve?

I'm just prone to the damned things. Allergies affecting the eyes, doncha know. Once you've had one, you are at risk for having more, but you're not DOOMED to having more. The ophthalmologists tell me you can prevent them by using an eyelid wash...you want to get it right where the eyelashes come out of the eye. Easier said than done on a li'l one. Hopefully she'll never have another one.

I went for years without having a single one, then had to have one stupid surgery after another for a few years, and now...nothing. It's been nice and quiet, eyelid-wise lately.

Of course, now I have this awful thing called POSTERIOR UVEITIS (totally unrelated...one doesn't cause the other), so instead of having injections on my eyelid, they just put them in my EYEBALL.

If you can stomach it, here's a link to some nice videos I had taken while they did this barbaric crap to me:

http://www.doctorsteve.com/2008/02/19/posterior-uveitis/#more-31

[oldladyfacepuncher]

http://www.doctorsteve.com/2008/02/19/posterior-uveitis/#more-31

Holy crap. I'd want to be out for that.