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Medical Mystery

Quillen College of Medicine

Last Week's Medical Mystery

    An 18-year-old previously healthy girl presents with an acute onset of pain, redness and swelling of her left eyelid and periorbital region of three days duration (see photo below). She denies visual loss or injection of the eye. Three days before the onset of her illness she had returned from a Caribbean cruise and thinks the problem may be related to her use of the ship's hot tub.
   What is your diagnosis, what test(s) would you do to confirm your suspicions, and what treatment, if any, do you advise?


DIAGNOSIS: Meibomitis, an infection of the oil-secreting meibomian gland which lies within the tarsal plate of the eyelid. Obstruction of the gland is usually caused by bacteria, notably staphylococcal species (S. aureus, S epidermis, S saccharolitycus) or proprionobacterium, although viruses and parasites (mites) have been implicated in some cases. The obstruction produces a chalazion, evident as a nodular swelling of the eyelid in the presented case. 
   There is no standardized treatment of meibomitis, with various regimens including doxycycline, minocycline, and azithromycin, plus drainage when necessary. Monitoring for meibomian gland dysfunction (defective tear production) is indicated.
   The presented case responded to an intramuscular injection of Rocephin, dainage, and a two week course of oral ciprofloxacin. The connection with her use of a hot tub is uncertain, since these most commonly lead to cutaneous infection with pseudomonas, a water organism, or, rarely, a hypersensitivity pneumonitis due to atypical mycobacteria.



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