This 20-month-old child has had a localized red mass on the right eyelid that had been present for a few weeks.
THE CASE: This 20-month-old child has had a localized red mass on the right eyelid that had been present for a few weeks.
Chalazion is the correct answer.
DISCUSSION: The mass is a chalazion-a chronic lipogranulomatous inflammation that arises from obstruction of the sebaceous glands of the eyelid. This swelling, caused by stasis of oily gland secretions, can become superinfected with Staphylococcus aureus.1
A localized lid swelling may also be the result of an acute infection of a lid follicle or meibomian gland (a hordeolum) or an insect bite. Clinically, it can be difficult to distinguish a chalazion from a hordeolum. The diagnosis is based on the symptoms and findings on gross inspection of the eyelid and eye. On rare occasions, a recurrent eyelid lesion can be a malignancy-such as a sebaceous carcinoma.
Frequent warm compresses encourage spontaneous drainage. Local superinfection may require topical or (rarely) oral antibiotics. Infrequently, incision and drainage and intralesional corticosteroid injection by an ophthalmologist may be required.1