What is a chalazion?
A chalazion is a red bump on your eyelid. It is sometimes called an eyelid cyst or a meibomian cyst. It slowly forms when an oil gland (called a meibomian gland ) becomes blocked.
At first, the chalazion may be painful, but after a little time, it usually doesn’t hurt. A chalazion usually forms on the upper eyelids but may occasionally form on the lower eyelid.
Ordinarily, chalazia (the plural of chalazion) develop in adults between the ages of 30 and 50. They are not common in children, but they can happen.
Is a chalazion a stye ?
A chalazion is not a stye, but it can form because of a stye. Styes are bacterial infections that cause the gland to swell. Styes can be painful. A chalazion generally isn’t painful and appears farther back on the eyelid.
Pathogenesis
A chalazion (meibomian cyst) is a sterile chronic granulomatous inflammatory lesion (lipogranuloma) of the meibomian, or sometimes Zeis, glands caused by retained sebaceous secretions.
Histopathology shows a lipogranulomatous chronic inflammatory picture with extracellular fat deposits surrounded by lipid-laden epithelioid cells, multinucleated giant cells and lymphocytes.
Blepharitis is commonly present; rosacea can be associated with multiple and recurrent chalazia. A recurrent chalazion should be biopsied to exclude malignancy
What causes chalazia ?
- Rosacea (a skin condition that causes redness and acne).
- Chronic blepharitis, eyelid inflammation (redness, swelling and irritation).
- Seborrheic dermatitis (red, dry, flaky and itchy skin).
- Viral infections.
Chalazia may develop when something blocks a small oil gland in the eyelid. These glands help keep the eye moist. A blocked gland begins retaining oil and swells. Eventually, the fluid will drain, and you may have a hard lump on your eyelid.
Some additional causes of chalazia are:
How is a chalazion diagnosed ?
- Health history: Give your complete health history. This information can help your provider find underlying issues that could be contributing to the formation of a chalazion.
- External eye exam: Your provider will examine your eye, eyelid, eyelashes and skin texture.
- Thorough eyelid exam: Eye specialists shine a bright light and use magnification to look at the base of your eyelashes. They also check the oil glands’ openings.
• Symptoms
○ Subacute/chronic: gradually enlarging painless rounded nodule.
○ Acute: sterile inflammation or bacterial infection with localized cellulitis differentiation may be difficult. A secondarily infected meibomian gland is referred to as an internal hordeolum.
• Signs
○ A nodule within the tarsal plate, sometimes with associated inflammation.
○ Bulging inspissated secretions may be visible at the orifice of the involved gland.
○ There may be an associated conjunctival granuloma.
○ A lesion at the anterior lid margin – a marginal chalazion – may be connected to a typical chalazion deeper in the lid or be due to isolated involvement of a gland of Zeis.
Treatment
• Oral antibiotics are required for significant bacterial infection, but not for sterile inflammation.
• Conservative. At least a third of chalazia resolve spontaneously so observation may be appropriate, especially if the lesion is showing signs of improvement, though early definitive treatment has been reported to lead to higher patient satisfaction.
• Hot compress application several times daily may aid resolution, particularly in early lesions.
• Expression. Compression between two cotton-tipped applicators is sometimes effective in expressing the contents of a fresh lesion near the lid margin.
• Steroid injection into or around the lesion has been reported to give similar resolution rates to incision and curettage. It may be preferred for marginal lesions or lesions close to structures such as the lacrimal punctum because of the risk of surgical damage.
○ Reported regimens include 0.2–2 ml of triamcinolone acetonide aqueous suspension diluted with lidocaine to a concentration of 5 mg/ml, and 0.1–0.2 ml of 40 mg/ml, injected with a 27- or 30-gauge needle.
○ The success rate following one injection is about 80%; a second can be given 1–2 weeks later.
○ Local skin depigmentation and fat atrophy are potential but uncommon complications, the risk of which may be reduced by avoidance of infiltration immediately subcutaneously or by utilizing a conjunctival approach.
○ Retinal vascular occlusion has been described as a complication, probably due to intravascular injection with subsequent embolization.
• Surgery
○ Following local anaesthesia infiltration, the eyelid is everted with a specialized clamp , the cyst is incised vertically through the tarsal plate and its contents curetted.
○ Limited excision of solid inflammatory material (sent for histopathology) with fine scissors may be helpful in some cases, especially if there is no focus of secretions.
○ A suture should not be used.
○ Topical antibiotic ointment is used three times daily for 5–7 days following curettage.
• Marginal lesions can be managed by steroid injection, by curettage of an associated deeper chalazion, by shave curettage or by incision and curettage via a horizontal incision on the conjunctival surface or vertically through the grey line.
Can a chalazion be prevented?
You may be able to avoid getting a chalazion by following good hygiene. Some essential elements of good hygiene include:
- Hand-washing: Wash your hands thoroughly and often. Before you touch your eyes, make sure to wash your hands.
- Contact lens care: Wash your hands before removing contact lenses. Make sure to thoroughly clean your contacts with a disinfectant and lens cleaning solution. Always throw daily and limited-time contacts away on schedule.
- Face-washing: Wash your face daily to remove dirt and makeup before going to bed. Your healthcare provider may recommend cleaning your eyelids with a special scrub or baby shampoo, especially if you’re prone to blepharitis.
- Makeup hygiene: Throw away all of your old or expired makeup. Be sure to replace mascara and eye shadow every two to three months. Also, never share or use another person’s makeup.
• Prophylaxis
○ Treatment of blepharitis, e.g. daily lid hygiene regimen.
○ Systemic tetracycline may be required as prophylaxis in patients with recurrent chalazia, particularly if associated with acne rosacea.