睑腺炎(麦粒肿)通常是在 5 至 7 天内自发消退的一种自限性病症。热敷和局部使用抗生素治疗有助于加速恢复并防止感染扩散。霰粒肿由于其更慢性的炎症性质而可能花费更长时间消退。
睑腺炎
以类似方式治疗内麦粒肿和外麦粒肿。因为大部分感染是由金黄色葡萄球菌引起,所以眼局部用杆菌肽或红霉素通常是足够的。除局部使用抗生素之外,施加于眼睑的热敷有助于加速自发消退和引流。大部分麦粒肿在5 至 7 天内消退很少全身使用抗生素,除非存在严重的周围蜂窝织炎。可以指定口服的第一代头孢菌素或阿莫西林/克拉维酸盐。[1]Wald ER. Periorbital and orbital infections. Infect Dis Clin North Am. 2007;21:393-408.http://www.ncbi.nlm.nih.gov/pubmed/17561075?tool=bestpractice.com[2]Mueller JB, McStay CM. Ocular infection and inflammation. Emerg Med Clin North Am. 2008;26:57-72.http://www.ncbi.nlm.nih.gov/pubmed/18249257?tool=bestpractice.com[3]Wald ER. Periorbital and orbital infections. Pediatr Rev. 2004;25:312-320.http://www.ncbi.nlm.nih.gov/pubmed/15342822?tool=bestpractice.com[4]Lederman C, Miller M. Hordeola and chalazia. Pediatr Rev. 1999;20:283-284.http://www.ncbi.nlm.nih.gov/pubmed/10429150?tool=bestpractice.com
对于造成视力扭曲的很大的麦粒肿或者对于内科治疗难以治愈的麦粒肿,应转诊至眼科医生或验光师进行切开和引流。[1]Wald ER. Periorbital and orbital infections. Infect Dis Clin North Am. 2007;21:393-408.http://www.ncbi.nlm.nih.gov/pubmed/17561075?tool=bestpractice.com[2]Mueller JB, McStay CM. Ocular infection and inflammation. Emerg Med Clin North Am. 2008;26:57-72.http://www.ncbi.nlm.nih.gov/pubmed/18249257?tool=bestpractice.com[3]Wald ER. Periorbital and orbital infections. Pediatr Rev. 2004;25:312-320.http://www.ncbi.nlm.nih.gov/pubmed/15342822?tool=bestpractice.com[4]Lederman C, Miller M. Hordeola and chalazia. Pediatr Rev. 1999;20:283-284.http://www.ncbi.nlm.nih.gov/pubmed/10429150?tool=bestpractice.com
霰粒肿
大部分霰粒肿使用热敷和适当眼睑卫生的保守治疗是有效的,包括用几滴婴儿香波冲洗受累眼睑。保持眼睑无眼屎、脓汁或结硬皮也有助于减轻该病症。不需要使用抗生素。[1]Wald ER. Periorbital and orbital infections. Infect Dis Clin North Am. 2007;21:393-408.http://www.ncbi.nlm.nih.gov/pubmed/17561075?tool=bestpractice.com[2]Mueller JB, McStay CM. Ocular infection and inflammation. Emerg Med Clin North Am. 2008;26:57-72.http://www.ncbi.nlm.nih.gov/pubmed/18249257?tool=bestpractice.com[3]Wald ER. Periorbital and orbital infections. Pediatr Rev. 2004;25:312-320.http://www.ncbi.nlm.nih.gov/pubmed/15342822?tool=bestpractice.com[4]Lederman C, Miller M. Hordeola and chalazia. Pediatr Rev. 1999;20:283-284.http://www.ncbi.nlm.nih.gov/pubmed/10429150?tool=bestpractice.com
对于复发性或难治性霰粒肿,可能需要转诊至眼科医生或验光师,以进行皮质类固醇注射或切开和刮除。两个选项的复发率大体相同并且通常比热敷和按摩更好。[6]Perry HD, Serniuk RA. Conservative treatment of chalazia. Ophthalmology. 1980;87:218-221.http://www.ncbi.nlm.nih.gov/pubmed/7422261?tool=bestpractice.com[7]Pizzarello LD, Jacobiec FA, Hofeldt AJ. Intralesional corticosteroid therapy of chalazia. Am J Ophthalmol. 1978;85:815-821.http://www.ncbi.nlm.nih.gov/pubmed/677208?tool=bestpractice.com[8]Goawalla A, Lee V. A prospective randomized treatment study comparing three treatment options for chalazia: triamcinolone acetonide injections, incision and curettage and treatment with hot compresses. Clin Experiment Ophthalmol. 2007;35:706-712.http://www.ncbi.nlm.nih.gov/pubmed/17997772?tool=bestpractice.com[9]Chung CF, Lai JS, Li PS. Subcutaneous extralesional triamcinolone acetonide injection versus conservative management in the treatment of chalazion. Hong Kong Med J. 2006;12:278-281.http://www.hkmj.org/system/files/hkm0608p278.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/16912354?tool=bestpractice.com