Eyelid infections involve inflammation or infection of the eyelid and surrounding tissues by bacteria, viruses, allergens or parasites. They are common in children. Most are mild and settle within days, but some can spread to the deeper tissues around the eye, so knowing the difference matters.
The commonest presentation is a child who wakes with a swollen eyelid. Behind that appearance there may be a simple stye, or a cellulitis that needs urgent treatment. What separates them is not the location of the swelling but the accompanying findings: fever, forward displacement of the eye, restricted eye movements and pain on looking around.
When styes keep coming back, an underlying cause should be sought. The commonest are chronic inflammation of the lid margin, an uncorrected refractive error that keeps the eyes straining, and constant rubbing due to allergy. For that reason I examine vision as well as the lids in recurrent cases. Lashes rubbing against the eye can also be a source of irritation and infection; see ingrown eyelashes.
For other childhood eyelid problems see structural disorders of the eyelid in children and pediatric eye diseases.
As an Ophthalmologist, Dr. Ayşe Dolar Bilge, I provide diagnosis and treatment services with my experienced team.
The commonest causes are styes, chalazia, inflammation of the lid margin and allergic reactions. Insect bites, sinusitis or a spreading upper respiratory infection can also cause swelling. Allergic swelling tends to be bilateral, itchy and painless, whereas infective swelling is painful and red and may come with fever.
A stye usually points and drains within a few days. Warm compresses speed this up: a clean cloth at a temperature that will not burn the skin, for a few minutes several times a day. Squeezing or trying to burst a stye is not advisable, because it can spread infection into the surrounding tissue.
A stye is an acute bacterial infection of an oil gland: painful, red and tender, settling within days. A chalazion is chronic inflammation from a blocked gland: a firm, painless lump that can persist for weeks. A large chalazion can press on the cornea and induce astigmatism, so vision is assessed as well.
If swelling comes with fever, if the eye is pushed forward, if eye movements are restricted or painful, or if vision is reduced or double, hospital assessment is needed without delay. These findings suggest the infection has reached the orbit. In a newborn, eyelid swelling with discharge is always assessed urgently.
Recurrent styes most often sit on a background of chronic inflammation of the lid margin. An uncorrected refractive error that keeps the eyes straining, and constant rubbing due to allergy, also feed recurrence. That is why I examine vision as well as the lids in recurrent cases.
Bacterial and viral eye infections spread readily by contact. Keeping the child's towel, pillowcase and face cloth separate, frequent handwashing and not sharing eye drops reduce transmission considerably. Chalazia and allergic swelling are not contagious.
Most chalazia settle over months with warm compresses and regular lid hygiene. A small drainage procedure is used for lesions that do not resolve, persist for a long time, or press on the cornea and affect vision. In children this is usually done under brief anaesthesia.
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