What are the treatment options for a chalazion?

Chalazion Treatment Options

Warm compresses and eyelid hygiene are the first-line treatment for chalazia, with more invasive options such as intralesional steroid injection or incision and curettage reserved for persistent or large lesions. 1

First-Line Conservative Management

Warm Compresses

• Apply warm compresses to eyelids for several minutes, 1-2 times daily 1
• Options include:
  • Hot tap water on a clean washcloth
  • Commercial heat pack
  • Homemade bean/rice bag heated in microwave
  • Caution: Avoid temperatures that could burn the skin 1

Eyelid Hygiene and Massage

• Perform vertical massage to express meibomian secretions 1
• Gently cleanse eyelid margins using:
  • Diluted baby shampoo on cotton ball/swab
  • Commercial eyelid cleaner
  • Hypochlorous acid 0.01% cleaners (strong antimicrobial effects) 1

Topical Antibiotics

• Apply antibiotic ointment (bacitracin or erythromycin) to eyelid margins at least once daily
• Continue for a few weeks as needed 1

Second-Line Interventional Management

For chalazia that persist after 4-6 weeks of conservative treatment or are large/bothersome:

Intralesional Steroid Injection

• Triamcinolone acetonide injection into the lesion 2
• Particularly useful for lesions in cosmetically sensitive areas

Surgical Management

• Incision and curettage - the standard surgical approach for persistent chalazia 1
• Subconjunctival approach offers excellent cosmetic results with minimal scarring 3
• Thermal cautery during surgery has not been shown to impact recurrence rates 4

Treatment Algorithm

1. Initial Presentation:

   • Begin with warm compresses and eyelid hygiene for 4-6 weeks
   • Add topical antibiotics for associated inflammation

2. After 4-6 weeks:

   • If resolved: discontinue treatment
   • If persistent but improving: continue conservative management
   • If no improvement or large/bothersome: proceed to interventional management

3. Interventional Management:

   • Consider intralesional steroid injection for smaller lesions or cosmetically sensitive areas
   • Perform incision and curettage for larger or non-responsive lesions

Special Considerations

When to Refer to an Ophthalmologist

Patients should be evaluated by an ophthalmologist if they experience:

• 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 1

Warning Signs for Potential Malignancy

• Recurrent chalazia in the same location
• Marked asymmetry
• Resistance to therapy
• Consider biopsy for these cases, especially in elderly patients 1

Treatment Efficacy

Research shows that conservative therapy alone (warm compresses with or without antibiotics) results in complete resolution in only about 18-21% of cases after 4-6 weeks 5. Chalazia present for more than 2 months are less likely to resolve with conservative therapy alone 5.

Potential Pitfalls

• Failing to recognize that untreated hordeola can progress to chalazia 1
• Using compresses that are too hot, risking skin burns 1
• Aggressive eyelid manipulation in patients with advanced glaucoma or filtering procedures 1
• Delaying interventional management for chalazia present for more than 2 months 5
• Failing to consider biopsy for recurrent chalazia in the same location (to rule out sebaceous carcinoma) 1