What is the treatment for a chalazion?

Chalazion Treatment

The treatment of chalazion should begin with conservative management including warm compresses, lid hygiene, and massage, but persistent or large chalazia require intralesional steroid injection or incision and curettage for definitive resolution. 1

Initial Assessment and Diagnosis

• A chalazion is a non-inflammatory eyelid lesion resulting from retained secretions in the meibomian or Zeis glands 2
• Characteristics differentiating chalazion from hordeolum:
  • Gradual onset (vs. acute for hordeolum)
  • Usually painless (vs. painful for hordeolum)
  • Firm, round nodule (vs. red, swollen, pointed for hordeolum)
  • Located within the tarsus 1

Treatment Algorithm

First-Line Treatment (Conservative Management)

• Warm compresses: Apply to affected eyelid for 5-10 minutes, 3-4 times daily 1
• Lid hygiene: Clean eyelid margins with mild soap or commercial lid scrubs
• Massage: Gentle massage to express contents of the chalazion 1
• Continue conservative treatment for 4-6 weeks 3

Second-Line Treatment (For persistent chalazia after 4-6 weeks)

• Intralesional steroid injection:

  • Triamcinolone acetonide (0.2 mL of 10 mg/mL)
  • 84% resolution rate at 3 weeks
  • Less painful and less inconvenient than surgery 4
  • May be preferred for children or anxious patients

• Incision and curettage:

  • 87% resolution rate at 3 weeks
  • More painful than steroid injection
  • More definitive for larger lesions 4
  • Preferred for recurrent or very large chalazia

Special Considerations

Pediatric Patients

• Conservative management remains first-line, but children may have unrecognized chronic blepharokeratoconjunctivitis requiring more aggressive treatment 1
• Tailored approaches considering underlying conditions are recommended for pediatric patients 5

Recurrent Chalazia

• Recurrent chalazia in the same location should raise suspicion for sebaceous carcinoma, especially in elderly patients 1
• Biopsy is indicated for:
  • Recurrent chalazia in the same location
  • Marked asymmetry
  • Resistance to therapy 1
• Consider underlying conditions such as subclinical hypothyroidism 6

Efficacy of Different Treatment Options

• Conservative therapy (warm compresses alone) shows complete resolution in only 46% of cases after 3 weeks 4
• Adding topical antibiotics (tobramycin) or antibiotics with steroids (tobramycin/dexamethasone) to warm compresses does not significantly improve resolution rates compared to warm compresses alone 3
• Chalazia present for more than 2 months are less likely to resolve with conservative therapy alone 3
• Intralesional steroid injection and incision and curettage have similar efficacy (84% vs. 87% resolution), but steroid injection causes less pain and inconvenience 4

Prevention of Recurrence

• Regular eyelid hygiene
• Address underlying conditions that contribute to meibomian gland dysfunction
• Complete the full course of recommended treatment
• Regular follow-up for patients with recurrent episodes 1

When to Refer to an Ophthalmologist

Patients should be evaluated by an ophthalmologist if they have:

• Visual loss
• Moderate or severe pain
• Severe or chronic redness
• Recurrent chalazia in the same location
• No improvement after 4-6 weeks of conservative treatment 7