Review Question - QID 104225

This patient most likely has a chalazion given the painless swelling on her eyelid that progresses to a nodular, rubbery lesion. Given the lack of response to warm compresses and the eyelash loss, excision is necessary to rule out malignancy.

A chalazion is the result of meibomian gland obstruction and presents with a firm/rubbery and non-tender nodule. The nodule forms on the conjunctival surface of the eyelid and is the result of granulomatous inflammation. This condition is self-limiting and does not require treatment. If persistent or recurrent, it may be a sign of meibomian gland carcinoma or sebaceous cell carcinoma. If there is any concern for malignancy (such as eyelash loss), excision should be performed as it will remove the lesion for cosmetic purposes and will allow for confirmation of the diagnosis.

Figure A displays a chalazion with a firm, rubbery nodule on the eyelid.

Incorrect Answers:
Answer 1: Biopsy to rule out malignancy would be suboptimal care. If this were a meibomian cyst, it is easily removed (thereby ameliorating symptoms) and is preferred over biopsy which is roughly just as invasive yet does nothing for symptom management. Given the concern for malignancy, excision is a better answer as it gives tissue for diagnosis and removes the lesion.

Answer 2: Cephalexin is an oral antibiotic that covers for most skin flora; however, a chalazion is not an infectious condition and will not respond to antibiotics.

Answer 4: Observation is not correct as this persistent lesion is concerning for malignancy warranting tissue diagnosis and treatment.

Answer 5: Warm compresses can be used to treat a hordeolum which presents with a firm and tender eyelid. It would not be appropriate management of a possible malignancy and this patient's symptoms already did not responded to this treatment.

Bullet Summary:
A chalazion that is persistent or is associated with hair loss should be excised as there is concern for malignancy.