From the Research
A chalazion should be incised and drained when it persists for more than 4-6 weeks despite conservative treatment, causes significant discomfort or visual disturbance, or is particularly large, as supported by the most recent study 1 from 2011. When considering the management of a chalazion, it is essential to prioritize the patient's morbidity, mortality, and quality of life. The primary goal is to alleviate symptoms, prevent complications, and improve the patient's overall well-being.
Initial Management
Before considering surgical intervention, patients should first attempt conservative measures, including:
- Warm compresses applied for 10-15 minutes, 4 times daily
- Lid massage for several weeks
- Antibiotic-steroid ointments like tobramycin/dexamethasone applied to the lid margin
Surgical Intervention
For persistent chalazia, an ophthalmologist can perform incision and drainage, typically under local anesthesia. The procedure involves:
- Everting the eyelid
- Making a small incision on the inner surface of the lid
- Removing the contents of the chalazion
- Sometimes administering a steroid injection (triamcinolone acetonide 5-10 mg/ml) into the lesion
This surgical approach is effective because it directly addresses the blocked meibomian gland that causes the chalazion, removing the accumulated sebaceous material and reducing inflammation, as shown in the study by 1.
Evaluation for Underlying Conditions
Patients with recurrent chalazia should be evaluated for underlying conditions like:
- Blepharitis
- Rosacea
- Seborrheic dermatitis as these may predispose to chalazion formation, according to the study by 2.
Comparison of Treatment Outcomes
A prospective, randomized study by 1 compared treatment outcomes of intralesional triamcinolone acetonide (TA) injection with incision and curettage (I&C) for primary chalazia, finding that both treatments were effective, with no significant difference in recurrence rates. However, the study by 3 from 2018 found that intralesional TA was as effective as I&C in both medium and large-sized primary chalazia.
Recommendation
Based on the most recent and highest-quality study 1, incision and drainage should be considered for chalazia that persist despite conservative treatment, cause significant symptoms, or are particularly large.