Chalazion

A chalazion is a sterile, chronic lipogranulomatous inflammation of a meibomian gland (and sometimes a gland of Zeis) caused by obstruction of the duct and retention and leakage of lipid secretion into the surrounding tarsal tissue.

• It is common in all ages, particularly in people with blepharitis, rosacea, seborrhoeic dermatitis, acne, diabetes, high cholesterol, and previous chalazia; also related to viral infections and poor lid hygiene.
• It can develop from internal hordeolum after the acute infection subsides.

• Gradually enlarging, firm, painless nodule in the upper or lower eyelid over days to weeks, with initial redness and mild tenderness that settles; may be multiple.
• Large lesions cause ptosis, pressure on the globe with induced astigmatism and blurred vision, and may point to the skin or conjunctival surface with discharge.
• Conjunctival surface: a red, grey, or purple elevation, sometimes a granuloma.
• Differences from hordeolum: chalazion is painless and non-inflammatory beyond the first days, whereas hordeolum is acutely painful and pustular.

• Clinical, with eversion of the lid to inspect the conjunctival side.
• Histological examination for recurrent chalazion in the same site, atypical appearance, unilateral loss of lashes, lid margin distortion, ulceration, or age over 50 years, because sebaceous gland carcinoma may masquerade as a chalazion.
• Evaluate systemic risks (diabetes, lipid profile) in multiple or recurrent lesions.

• Conservative therapy for 4 to 8 weeks (up to 40 to 50 percent resolve): warm compresses for 10 minutes four times daily with gentle massage toward the lid margin, and lid hygiene.
• Intralesional corticosteroid: triamcinolone acetonide 10 mg/mL injected into the lesion, 0.1 mL to 0.2 mL (0.2 mL to 0.5 mL of 5 to 10 mg/mL for larger lesions), directly through the conjunctiva with a 25 to 27 gauge needle; repeat once after 2 to 4 weeks if incomplete. Higher concentration or volume risks skin depigmentation (especially darker skin), fat atrophy, and rarely retinal embolisation or central retinal artery occlusion with accidental intravascular injection.
• Incision and curettage under local anaesthesia (lidocaine 2 percent with adrenaline 1 in 100,000) for persistent, large, or vision affecting chalazia: apply a chalazion clamp, make a vertical incision through the tarsal conjunctiva (to avoid scarring and disruption of adjacent glands), curette contents, and cauterise or close; skin incision is used for lesions pointing anteriorly. Send tissue for histology if suspicious.
• Postoperative: topical antibiotic ointment (chloramphenicol 1 percent or erythromycin 0.5 percent) for 5 to 7 days, pad for 1 to 2 hours for haemostasis, then continue warm compresses.
• Children: observe for months; surgery under general anaesthesia if needed; evaluate for amblyopia from astigmatism or ptosis.
• Oral antibiotics only if secondary infection is present: flucloxacillin 500 mg every 6 hours for 5 to 7 days, or cefalexin 500 mg every 8 hours; clindamycin 300 mg every 8 hours if penicillin allergic.
• Prevent recurrence: daily lid hygiene, treat blepharitis, rosacea (doxycycline 100 mg daily for 6 to 12 weeks), and omega-3 supplements.
• Complications: recurrence, infection, ptosis, astigmatism, lid notching, skin depigmentation, and lash loss.