Chalazion Treatment
The first-line treatment for chalazia is warm compresses and eyelid hygiene, which should be tried for 4-6 weeks before considering more invasive options. 1
Initial Conservative Management
Warm Compresses
- Apply warm compresses to eyelids for several minutes, 1-2 times daily 1
- Options for warm compresses include:
- Clean washcloth with hot tap water
- Commercial heat pack
- Homemade bean/rice bag heated in microwave
- Hard-boiled eggs (shown to have good heat retention) 2
- Important: Ensure temperature is not hot enough to burn skin 1
Eyelid Hygiene
- Gently cleanse eyelid margins to remove crusting
- Use diluted baby shampoo or commercial eyelid cleaner on a cotton ball/swab 1
- Hypochlorous acid 0.01% cleaners have strong antimicrobial effects 1
Second-Line Treatments
If no improvement after 4-6 weeks of conservative treatment, consider:
Intralesional Steroid Injection
- Triamcinolone acetonide injection (0.2 mL of 10 mg/mL)
- Success rate of approximately 84% 3
- Less painful and more convenient than surgical options 3
Incision and Curettage
- Surgical removal of the lesion
- Success rate of approximately 87% 3
- More painful than steroid injection but highly effective 3
Treatment Algorithm
Start with conservative therapy (4-6 weeks)
- Warm compresses + eyelid hygiene
- Consider adding topical antibiotic ointment (bacitracin or erythromycin) 1
If no improvement after 4-6 weeks:
- Consider intralesional steroid injection OR
- Proceed to incision and curettage
For recurrent chalazia in the same location:
- Refer for evaluation of underlying conditions
- Consider biopsy to rule out sebaceous carcinoma, especially in elderly patients 1
Special Considerations
Duration of Chalazion
- Chalazia present for more than 2 months are less likely to resolve with conservative therapy alone 4
- Consider earlier intervention with steroid injection or surgery for long-standing chalazia
Pediatric Patients
- Conservative treatment remains first-line for children 5
- Consider evaluation for underlying conditions like vitamin A deficiency, Demodex infestation, or rosacea in recurrent cases 5
- Children with recurrent chalazia may have unrecognized chronic blepharokeratoconjunctivitis requiring more aggressive treatment 1
Common Pitfalls to Avoid
- Using compresses that are too hot, which may burn the skin 1
- Failing to recognize that untreated chalazia can progress to complications 1
- Aggressive eyelid manipulation in patients with advanced glaucoma or filtering procedures 1
- Missing sebaceous carcinoma in elderly patients with recurrent chalazia in the same location 1