From the Research
A chalazion should be incised and drained when it persists for more than 1-2 months despite conservative treatment, causes significant discomfort or visual disturbance, or is particularly large, as supported by the most recent study 1. When considering the management of a chalazion, it is essential to prioritize conservative measures first, including warm compresses and gentle eyelid massage, sometimes combined with antibiotic-steroid combination ointments.
- Warm compresses should be applied for 10-15 minutes, 4 times daily.
- Gentle eyelid massage can help express the sebaceous material.
- Antibiotic-steroid combination ointments like tobramycin/dexamethasone can be applied to the eyelid margin. If these measures fail, incision and drainage becomes an appropriate consideration.
- The procedure is typically performed under local anesthesia.
- A small incision is made on the inner surface of the eyelid to avoid scarring the visible skin.
- Curettage is then used to remove the accumulated material. The decision to proceed with incision and drainage is justified by the fact that persistent chalazia contain inspissated sebaceous material that becomes walled off by granulation tissue, making spontaneous resolution unlikely 1. After the procedure, patients should continue warm compresses for several days and may be prescribed antibiotic drops or ointment like erythromycin or bacitracin to prevent infection. It's also worth noting that intralesional triamcinolone acetonide injection is as effective as incision and curettage for primary chalazia, and may be considered as an alternative first-line treatment in cases where diagnosis is straightforward and no biopsy is required 1.