Chalazion

From EyeWiki
Original article contributed by: Wong Lai Man, Raymond
All contributors: Brad H. Feldman, M.D., Cat Nguyen Burkat, MD FACS, Matthew Zhang, Wong Lai Man, Raymond and Shubhra Goel, MD
Assigned editor: Cat Nguyen Burkat, MD FACS
Review: Assigned status Up to Date by Cat Nguyen Burkat, MD FACS on September 2, 2015.
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Chalazion is a common condition usually presenting as eyelid swelling or painless nodule over eyelid. It affects upper eyelid more commonly than lower lid because there are more meibomian glands in the upper lid. This condition affects both sex equally and occurs in all age group.

Visit EyeSmart from the American Academy of Ophthalmology for a brief, patient-friendly summary of chalazion.

Chalazion Image from EyeRounds Online Atlas of Ophthalmology Contributor: Jordan M. Graff, MD, University of Iowa Category: External Disease Diagnosis: Chalazion

Disease Entity[edit | edit source]

Chalazion is a subcutaneous nodule in the upper or lower eyelid.

Disease[edit | edit source]

Chalazion is a chronic sterile granuloma residing within eyelid that originates from an obstructed meibomian gland of the tarsal plates. If acute secondary infection (e.g. Staphylococcus aureus) takes place, the lesion is known as hordeolum.

Etiology[edit | edit source]

Chronic granulomatous reaction in the eyelid induced by retained sebaceous secretions from meibomian gland.

Risk Factors[edit | edit source]

History or blepharitis, rosacea, prior chalazion, or any type of eyelid inflammation. Other factors can be uncorrected refractive errors and uncontrolled diabetes, long hours of work on computers.

General Pathology[edit | edit source]

Histology of the lesion will reveal cells characterizing chronic granulomatous inflammation, namely multinucleated giant cells and epithelioid cells (lipid-laden macrophages in this case). Lymphocytes and plasma cells may also be present.

Pathophysiology[edit | edit source]

Meibomian glands are sebaceous glands located in the tarsal plate of eyelid. Their secretion includes polar and non-polar lipids, which are components of tear film. If the outflow of these sebaceous secretions is obstructed, the oily secretions are retained and may leak into the adjacent tissue, which will in turn induce chronic granulomatous inflammatory response leading to formation of lipogranuloma.

Primary prevention[edit | edit source]

Regular massage and warm compresses can help in drainage of the sebaceous secretion and therefore decrease occurrence or recurrence of chalazion. Maintaining good lid hygiene may also be beneficial.

Diagnosis[edit | edit source]

Diagnosis is by clinical findings. Further workup for confirmation is usually not necessary except in recurrent cases where sebaceous gland carcinoma needed to be excluded.

History[edit | edit source]

Patient usually presents with gradually enlarging eyelid nodule, eyelid discomfort or even painful swelling if secondary infection occurs. Many patients would have history of similar eyelid swelling in the past

Physical examination[edit | edit source]

On examination of the eyelid, a solitary, non-tender nodule should be noted in the tarsal plate. Eversion of eyelid may help identifying the lesion if it is not apparent over skin surface.

Clinical diagnosis[edit | edit source]

Clinical diagnosis is usually based on patient's history and appearance of the lesion.

Diagnostic procedures[edit | edit source]

Slit-lamp examination to assess the condition of the meibomian glands (which often show diffuse inspissation of yellowish contents from the eyelid margin orifices). The eyelid should be everted to exclude other pathologies, such as a retained foreign body, or tarsal cyst.

Laboratory test[edit | edit source]

Usually not necessary. Microscopy of the materials from chalazion shows chronic inflammatory cells and occasionally acute inflammatory cells such as polymorphs.

Differential diagnosis[edit | edit source]

Malignant or benign tumours such as sebaceous gland tumour; Inflammatory conditions including cellulitis, dermatitis; Insect bite; tarsal cyst

Management[edit | edit source]

Small, asymptomatic chalazion can be left untreated. Conservative treatment including lid massage, warm compression and steroid eyedrops can also be used. However, with administration of topical or local steroid agents, the intraocular pressure should be monitored.

Topical antibiotics eyedrops is useful if lesion is associated with inflammatory conditions such as blepharitis; Direct injection of steroid with lignocaine into the lesion may be preferable for lesions in close proximity to the vulnerable lacrimal apparatus where surgical drainage is difficult. Steroid injection leads to resolution in most cases; repeated injection can be given 1-2 weeks later if lesion persists.

Medical therapy[edit | edit source]

Prophylactic systemic tetracyclines (such as doxycycline) can be considered in recurrent cases. There may be a role for topical antibiotics prophylaxis with macrolide antibiotics (such as erythromycin ointment or Azithromycin gel).

Surgery[edit | edit source]

Surgical treatment may be considered in case of unresolved chalazion or large and symptomatic chalazion. Incision and curettage is the treatment of choice.

Local anaethestic agent is injected to the area surrounding the lesion. Eyelid is then everted with special clamp and incision is made through conjunctiva. Contents of chalazion are curetted, and tarsus may be minimally resected if indicated. Since the operation is done at the inner side of eyelid, no scar will be seen over the anterior aspect of the lid.

Preferably, specimens obtained during the procedure should be sent to pathology and obtain and final read, to rule out other dangerous diagnoses.

Surgical follow up[edit | edit source]

Patient may be seen again in several weeks, or follow-up as required. The inflamed lid may still take several weeks to completely resolve.

Complications[edit | edit source]

Large chalazion can occasionally exert mass effect on cornea and result in astigmatism and blurred vision; Acute secondary infection leading to pain that may require incision and curettage.

Transconjunctival steroid injection may lead to local skin depigmentation or atrophy of skin.

Prognosis[edit | edit source]

Excellent prognosis could be expected. Untreated chalazion usually resolves spontaneously in weeks. However, recurrence is common.

Additional Resources[edit | edit source]

American Academy of Ophthalmology Preferred Practice Patterns (AAO)

Want a brief, patient-friendly summary of chalazion? Check out geteyeSmart.org


References[edit | edit source]

  1. Khan JA, Doane JF, Grove AS Jr. Ophthal Plast Reconstr Surg. 1991;7(1):61-6. Review.