Week 33 Q&A

A 4-year-old girl presents with a history of a nodule on the right upper lid.
Week 33 Q&A

It has been present for 2 weeks. The skin over the nodule is mildly erythematous. The child denies any pain. You also notice some scurf on the lashes of both eyes. The girls’ mother has a history of rosacea.

What is the most likely diagnosis?

A. Chalazion.

B. Molluscum contagiosum.

C. Stye.

D. Rhabdomyosarcoma.

E. Capillary hemangioma.

The correct answer is “A.” Chalazia are lipogranulomatous inflammations resulting from obstruction of the meibomian glands, which are modified sebaceous glands. Chalazia are noninfectious in nature. In contrast, a stye (hordeolum) is a painful acute infection often caused by Staphylococcus aureus. An external hordeolum involves the glands of Zeis or Molls gland, while an internal hordeolum affects the meibomian glands. The meibomian glands are located in the tarsus, which is more posterior in location. The glands of Zeis are located at the base of eyelash hair follicles and therefore more anterior. Distinguishing clinically between a chalazia and stye can be difficult. Both can be associated with rosacea, which is a disease affecting the sebaceous glands. 


Question & Explanation: Peterson AR, Wood KE. Pediatrics Examination and Board Review. New York, NY: McGraw-Hill Education; 2017.

Photo: Lueder GT. Pediatric Practice: Ophthalmology; 2011.