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.