pus coming out of meibomian gland opening in upper eyelid

[ywds]

I have pus coming out of a meibomian gland opening and a bit of the tarsal conjunctiva in my upper eyelid near the nasal side for almost a week now. I guess it must be an infection but I also have a chalazion-like lump at the same site of the infection.
Id like to know whether the white cells can enter the meibomian gland by difussion through its wall or all I have is a meibomian gland blockage and the gland wall has broken releasing the oil into the eyelid tissue and thus causing an inflamatory reaction. Im currently using chloramphenicol and cortisone with no signs of improvement.

Thanks

[ywds]

I hope warm compresses will unblock the meibomian gland.

Many thanks for your help

[CSBDR]

The photo is consistent with a chalazion, external skin injection mid-way up the lid and your description of redness and swelling on the tarsal conjunctiva.  I agree there are no signs of periorbital cellulitis.

The tetracycline family of antibiotics is quite beneficial for the treatment of blepharitis and meibomianitis.  It is not real helpful in an acute setting, but helps in preventing future obstructions by altering the composition of the meibomian secretions.  Common side effects are GI sensitivity and photosensitivity.  They are often prescribed for a month or two, and then stopped for a few months.  Oral omega-3 fatty acids also have some of the beneficial effect on meibomian secretions, and can be taken chronically.

Another helpful preventative measures are hot compresses over the lid edges once or twice daily.  Some eye docs are seeing good effect with Azasite solution applied directly to the eyelid edges, again for a month or two at a time.

Good luck, and seek the care of a good eyeMD

[ywds]

Here is a picture of the chalazion/internal hordoleum. I think I don't have periorbital cellulitis.
http://www.medhelp.org/user_photos/show/128420?personal_page_id=993859

I guess I got an infection due to blepharitis and meibomian gland dysfunction and this caused a blockage of the meibomian gland. I'm worried that the internal hordeloum turns into a chalazion.

Do you think Doxycyline may help treat MGD and bacterial infection at the same time?

[CSBDR]

Actually, chalazion is a blockage of the meibomian gland, which can be acute (some call it "internal hordeolum") and drain.  Most hordeola are external and associated with infection of a lash follicle.

If oral antibiotics are indicated, cephalexin is commonly used, dosages of 500mg 3 or 4 times daily for a week is usually adequate.  Doxycycline and Dicloxacillin are uncommonly used.

[ywds]

what oral antibiotic and dosage is used to treat internal hordeolum: Doxycycline or Dicloxacillin?

[Ray T Oyakawa, MD]

Technically, a chalazion is a long standing hordeloum (stye) and they do not drain.  An acute hordeolum can drain.

Dr. O.

[CSBDR]

You have a draining chalazion, which is visible at the meibomian orifice and posteriorly on the tarsal conjunctiva.  Blockage of the gland is the primary pathophyiosologic process, and significant vascularization in the eyelid makes it easy for inflammatory mediators to enter the site.

Treatment of an "acute" chalazion is primarily heat to open the orifice and promote drainage.  Gentle massage may be of benefit too.  Oral antibiotics can be helpful as there is some infectious component, certainly if there is a periorbital cellulitis.  Topical antibiotics have no real benefit, as Dr. O said, certainly not a poorly-penetrating drop.  Topical steroids may somewhat reduce swelling, but aren't necessary

[ywds]

It is not a stye. The lump is away from the eyelid margin and above the affected meibomian gland.
I wonder why the pus is coming out just of a single meibomian gland opening. I guess warm compresses may worsen the blockage as on previous occasions.

[Ray T Oyakawa, MD]

No one here uses choramphenicol anymore.  Treatment for a stye is warm compresses.  See your doctor.

Dr. O.