A swollen, painful eyelid prompted a 39-year-old man to seek medical attention.
The patient had noticed swelling, redness, and irritation in his left lateral eyebrow
area 2 days earlier. Upon awakening on the morning of his appointment,
the left upper eyelid also felt full and tender and was drooping. A pointed draining
area of purulent material had formed in the lateral brow region (not visible
here). The patient was afebrile and denied any recent periorbital trauma. He
was otherwise healthy; his only medication was a daily multivitamin.
Mechanical ptosis can occur when tumors or edema force the lid to droop.
Often the mobility of the eyelid can be impaired. To correct the condition, treat
the underlying cause.
This patient was told to use hot compresses to hasten the pointing and
resolution of the abscess. Cephalexin was prescribed, because Staphylococcus
infections cause the vast majority of abscesses and microabscesses of the lids
and periocular area. Monitor such patients for staphylococcal septicemia, orbital
cellulitis, and cavernous sinus sepsis.
Reserve incision and drainage for recalcitrant cases. Because the orbital
septum acts as an effective barrier to the spread of infection into the orbit, take
care not to open it in the course of incision and drainage.1
1. Griffith DG, Salasche SJ, Clemons DE, eds. Cutaneous Abnormalities of the Eyelid and Face: An Atlas With
Histopathology. New York: McGraw-Hill; 1987:312-316.