Pediatrics: Ddx Of Bumps & Swelling Eyelids

Front 1

- An acute infection of oil glands
- Localized, painful, erythematous, & edematous
- 90 - 95% caused by staphyloccocus aureus

1) External Hordeolum
- involves Glands of Zeis or Moll

2) Internal Hordeolum
- involves Meibomian Glands

Back 1

Hordeolum

Front 2

- Chronic, granulomatous inflammation of meibomian glands
- Localized, painless, slow growing
- If large, may press on eye, inducing astigmatism

Back 2

Chalazion

Front 3

- Sometimes acute pain, redness, & swelling around the lacrimal sac
- Usually chronic, indolent form
- Often associated with nasolacrimal duct obstruction
- Fever or systemic symptoms may occur
- H. Influenza or S. Pneumoniae

Back 3

Dacryocystitis

Front 4

- Newborn baby, bluish, distended cyst of lacrimal sac
- Both nasolacrimal duct & the common internal punctum are closed in utero
- Often become infected in the 1st few days of life if untreated
- Usually need probing

Back 4

Dacryocystocele

Front 5

- Unilateral, painful lid edema with systemic symptoms

1) Preseptal Cellulitis
- affects tissue anterior to the orbital septum (more common)

2) Orbital Cellulitis
- affects deeper orbital tissues (behind septum)

- Caused by:
1. Staphylococcus aureus
2. H. Influenza
3. Streptococcus pneumoniae

Back 5

Cellulitis

Front 6

Which type of cellulitis requires immediate treatment?

Back 6

Orbital Cellulitis needs immediate treatment:

- Vision loss results if optic nerve is affected

- Life-threatening if infection spreads into the cavernous sinus

Front 7

The most common eyelid & orbital tumor in infants.

- Vascular tumors with rapid onset near birth, continue to enlarge till 18 months of age
- Most hemangioma regress spontaneously by age 7

Back 7

Capillary Hemangioma

Front 8

Can amblyopia develop in Capillary Hemangioma patients?

Back 8

Yes, amblyopia can develop due to:
1) form deprivation
2) induced astigmatism

Front 9

What's the treatment for Capillary Hemangioma?

Back 9

Steroid injections

Front 10

- Benign, congenital tumor
- Firm, smooth, painless
- May cause proptosis, ptosis, restriction of ocular motility
- May induce astigmatism

- Some associated with Goldenhar's Syndrome:
- epibulbar dermoids
- preauricular appendages
- vertebral anomalies

Back 10

Dermoids

Front 11

What are other causes of bumps on lids?

Back 11

1. Orbital cysts

2. Molluscum Contagiosum
- Poxvirus

3. Juvenile Xanthogranuloma
- benign red/yellow papules or nodules on scalp & face can infiltrate the uvea leading to hyphema.

Front 12

A 3 y/o boy presents with eyelid bump on left eye.
- Pt c/o NO redness or tender to touch.
- Loss of lashes
- Telangectasia

What's the Dx?

Back 12

Basal Cell Carcinoma

Front 13

"My child has a bump on her eyelid or swelling of eyelid"

What's the possible DDx?

Back 13

1. Hordeolum
2. Chalazion
3. Orbital/Preseptal Cellulitis
4. Dacryocystitis - blocked puncta
4b. Dacryocystocele
5. Capillary Hemangioma
6. Dermoids

7. Orbital cysts
8. Molluscum Contagiosum
9. Juvenile Xanthogranuloma

10. Basal Cell Carcinoma

Front 14

- Newborn baby, Bluish, distended cyst of lacrimal sac.
- Both lacrimal duct & the common internal punctum are closed in utero.
- Often become infected in the first few days of life if untreated.
- Usually need probing.

Back 14

Dacryocystocele