Which condition is typically acute in onset?

• A. Hordeolum
• B. Chalazion
• C. Blepharitis
• D. Conjunctival pinguecula

Answer: (A)

The main concept is that acute eyelid lesions are typically infectious and present with rapid onset and pain, while chronic eyelid conditions tend to be noninfectious, slower to develop, and less acutely painful.

A hordeolum is an acute infection of the eyelid glands (external glands like Moll or Zeis, or internal meibomian glands) that produces a sudden, painful, red, and swollen lump at the eyelid margin, often with eyelash discharge. This rapid onset and tenderness reflect the infectious process driving the acute presentation.

Chalazion, in contrast, is a chronic, noninfectious inflammatory reaction to gland obstruction that yields a painless, slowly enlarging lump on the eyelid, developing over weeks rather than hours to days. Blepharitis is an ongoing inflammatory condition of the eyelid margins characterized by irritation, redness, and crusting, typically with a chronic course and fluctuating symptoms rather than a single acute lump. Conjunctival pinguecula is a benign, normally slow-developing thickening of the conjunctiva on the limbus, usually asymptomatic or only mildly irritated, not presenting with an acute painful eyelid swelling.

Therefore, the condition that is typically acute in onset is the hordeolum because its infectious process leads to rapid, painful eyelid swelling, unlike the others.