Young people stay up late, often wear makeup, waterproof mascara and false eyelashes are glued on and off, have acne on their faces, and often have small bumps on their eyelids that recur frequently? Let’s figure out the etiology and treatment of small eye lumps. A. Needle eyes, wheals, facial adenitis = bacterial infection Wheals are the ophthalmic “pimples” of adolescents, starting with red, swollen and painful eyelids and small pus heads (Figure 1), then breaking down and flowing pus or oil, which heals after 7-10 days. This is caused by the sweat or sebaceous glands at the base of the eyelashes being clogged with sebum and dander, and the Staphylococcus aureus bacteria multiplying inside. Macrophthalmia does not affect vision and can be self-treated at home by cleaning the roots of the eyelashes daily (using a tear-free formula baby bath or a special eyelid cleansing foam) and applying hot compresses to the eyes without squeezing or picking. Oral acetaminophen can relieve pain and the use of antibiotic eye drops will speed healing. Second, chalazion = blocked opening Unlike the anatomical location of mydriasis (Figure 2), chalazion, also called a chalazion cyst, is a blocked opening in the lid gland and a mass of accumulated secretions that is not painful. Chalazia usually does not require antibiotic drops. Hot compresses and lid gland massage can speed up the drainage of the oil, and it will absorb itself in a few weeks to a few months. If it does not decrease in size in a month but increases in size, you will need to see an ophthalmologist. The frequency of hot compresses is four times a day for 15 minutes each time. A dry heat pack will loosen the hardened oil in the lid gland ducts and make it easier to drain. Wet heat packs can relax muscle spasms, such as eyelid jumping. 2, lid gland massage People can massage themselves: wash their hands, apply a hot compress to both eyes for 10 minutes, fix the upper eyelid with the left index finger, slide the right index finger from top to bottom to the root of the eyelash (or use a cotton swab), from the corner to the end of the eye, and the lower eyelid needs to be wiped from bottom to top, and finally the root of the eyelash. (1) Surgical removal or conservative treatment In theory, surgery is recommended for chalazia that is not absorbed for more than one month. Especially in middle-aged and older adults, waiting for spontaneous healing is not recommended, and the excised tissue will be examined pathologically and diagnosed to rule out adenocarcinoma of the lid, intrapalpebral keratosis cyst of the lid gland, and metastatic cancer of the eyelid. Although spontaneous remission of chalazia in adolescents and young adults has been reported after 3-5 years. However, chalazia larger than 5 mm in the upper eyelid can cause astigmatism by compressing the cornea and can even cause central flattening of the cornea, leading to hyperopia. All of these refractive changes will return as before after the chalazion subsides or is removed. Some studies have concluded that surgery should be considered directly in patients who are older than or equal to 35 years of age, who have had the lesion for longer than or equal to 8.5 months, and who have chalazia larger or smaller than or equal to 11.4 mm. (2) Surgical excision or hormonal injection For primary and recurrent chalazia, intra-lesion injection of tretinoin (40 mg/ml) is an effective treatment. After 1-2 injections, the chalazion resolves within 2.5 weeks in 80% of patients. Patients with combined blepharitis require multiple injections, and chalazia that is ineffective with 2-3 injections requires surgical excision. Complications of the injections are rare, do not affect intraocular pressure or vision, and there are no complications such as subcutaneous fat atrophy or skin pigmentation changes, and they are equally effective in both adults and children.