Simultaneous and recurrent hordeola and chalazia associated with tirzepatide therapy: a case series

Glucagon-like peptide-1 (GLP-1) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists are increasingly prescribed for obesity and type 2 diabetes, but eyelid gland pathology has not previously been reported with these agents. We describe what we believe to be the first reported case series of 2 patients who developed multiple simultaneous internal hordeola after starting tirzepatide, a dual GLP-1/GIP receptor agonist. Patient 1, a 44-year-old woman, developed 6 simultaneous hordeola 4 weeks after dose escalation, 5 of which progressed to chalazia; lesions lessened after tirzepatide discontinuation and worsened upon rechallenge, a positive rechallenge providing strong evidence of causality. Patient 2, a 73-year-old woman with mild pre-existing blepharitis, developed 6 simultaneous hordeola 10 weeks after initiation of her 5 mg dose, 2 of which progressed to chalazia. Both patients lacked classic infectious blepharitis signs despite active lesions, supporting a sterile, obstructive meibomian gland process rather than infection, though both found the recurrences bothersome. These cases suggest a possible, previously undescribed association between tirzepatide and simultaneous or recurrent meibomian gland obstruction. Clinicians should be aware of this potential adverse eyelid effect and pursue conservative ophthalmic management before considering medication changes.