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Introduction
Case
A 23 year old male presents with a lesion on his right upper lid. He says he first noticed the lesion approximately 6 weeks ago, at which time it was red and painful. Over the following weeks, the redness and pain subsided but he still has a visible nodule on the right upper lid. He reports not other complaints such as red eye, decreased vision, or diplopia. His past ocular and medical history is unremarkable.
On exam, a firm nontender nodule is palpated deep in the right upper lid close to the lid margin. The lesion does not appear inflamed. The patient also has evidence of some mild blepharitis, with a small amount of thick white discharge expressed from glands with lid pressure.
What is the most likely diagnosis?
Stye
A stye is an infection of the sebaceous glands at the lid margin that produces a red bump that is often painful. In its acute stage, a chalazion can often appear similar to a stye.
Sebaceous cell carcinoma
Although sebaceous cell carcinomas should be considered in the differential diagnosis of a lid lesion, the acute onset and presentation typical of a chalazion make it less likely. However, sebaceous cell carcinoma should be suspected if the lesion is atypical or poorly responsive to treatment.
Chalazion
CORRECT
Insect bite
There are no features in the case that suggest an insect bite as the cause of the lid lesion.
A chalazion or meibomian cyst is a benign lesion of the eyelids occurring as a result of obstruction to a meibomian gland or gland of Zeis. They are most common in adults and occur equally in males and females. They are the most common inflammatory lesions of the eyelid.1