The most common eyelid lump presenting in children is a chalazion. This is a benign mass but it can cause irritation symptoms like eye redness, sticky lids, and mild tearing. It is a collection of lipogranulomatous inflammatory tissue as a result of a blocked meibomian gland duct in the eyelid. It usually presents as a localized painless nodule in the lid or lid margin, which may or may not be accompanied by swelling. A small chalazion resolves spontaneously, so it need not be excised. Warm compresses several times a day with eyelid scrubbing twice a day helps drain the lipid material, decompressing the chalazion. Topical antibiotics can be useful if inflamed. Oral antibiotic may be given when cellulitis has set in. A larger chalazion may need incision and curettage under general anesthesia. The chronic form that does not respond to several weeks of treatment warrants a suspicion of malignancy.
Another benign lid mass in small children is an external hordeolum. Commonly called a stye, it is a painful abscess of the sebaceous gland of the lid, and is often associated with Staphylococcus aureus infection. A stye may resolve spontaneously, but antibiotic ointment is helpful in relieving some of the discomfort. Oral antibiotic may be given when cellulitis is present. Children with larger abscesses require systemic antibiotics, as well as incision and drainage under anesthesia.
As in all young children with a lump in the lid of any cause, the risk of amblyopia by distortion of the globe or partial occlusion of the visual axis must not be overlooked. It is important to monitor the visual acuity of children with very large lumps in the lid.
Wu, A., Gervasio, K., Gergoudis, K., Wei, C., Oestreicher, J., and Harvey, J. (2018). Conservative therapy for chalazia: is it really effective? Acta Ophthalmol, 96(4): e503-e509.
MD, DPBO, FPAO, FPCS
Dr. Barbara Roque is a specialist in pediatric ophthalmology, adult strabismus, and ophthalmic genetics. Her private practice began in 2006, after her post-graduate fellowship training at The Children’s Hospital in Westmead, University of Sydney System, Australia. Her patients are mostly children with ocular disease, refractive errors, cataracts, and eye misalignment.