The opening of the meibomian glands could become infected at any age, resulting in mei-bomitis, seen initially as redness along the line of a gland when the eyelid is everted. A small abscess might then form, with swelling and redness of the whole eyelid, and this can point and burst either through the conjunctiva or less often through the skin. The orifice of a gland could become occluded and the gland then becomes distended and cystic. The retained secretions of the gland set up a granulating reaction and the cyst itself might become infected. The patient might complain of soreness and swelling of the eyelid, which subsides, leaving a pea-sized swelling that remains for many months and sometimes swells up again. During the stage of acute infection, the best treatment is local heat, preferably in the form of steam. This produces considerable relief and is preferable to the use of systemic or local antibiotics. Antibiotics might be required if the patient has several recurrences or if there are signs and symptoms of septicaemia. Once a pea-sized cyst remains in the tarsal plate, this can be promptly removed under a local anaesthetic unless the patient is a child, in which case a general anaesthetic might be required. The method of removal involves everting the eyelid and incising the cyst through the conjunctiva and then curetting the contents. Postoperatively, local antibiotic drops or ointment are prescribed (Figure 5.11).
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