From the Guidelines
A chalazion is a small, painless bump that forms on the eyelid due to a blocked oil gland, and treatment typically begins with warm compresses applied to the affected eyelid for 10-15 minutes, 4-6 times daily to help soften the oil and promote drainage, as recommended in the most recent guidelines 1. The goal of treatment is to reduce inflammation, promote drainage, and prevent infection.
- Warm compresses can be applied using a clean washcloth, over-the-counter heat pack, or homemade bean/rice bag that can be heated in the microwave, as suggested in the blepharitis preferred practice pattern 1.
- Gentle massage of the area after applying the warm compress can help express the blocked material, and eyelid cleansing can be accomplished by brief, gentle massage of the eyelids or using eye cleaners with hypochlorous acid at 0.01% 1.
- Over-the-counter pain relievers like ibuprofen (200-400mg every 6 hours) or acetaminophen (500-1000mg every 6 hours) can help if there's discomfort, and maintaining good eyelid hygiene by cleaning the eyelids daily with baby shampoo diluted in warm water is essential. Most chalazia resolve within 2-8 weeks with these conservative measures, but if the chalazion persists beyond 4-6 weeks, grows very large, affects vision, or becomes infected, medical attention is necessary, and a doctor may prescribe antibiotic eye drops or ointment for infection or perform a minor surgical procedure to drain the chalazion, as indicated in the guidelines for blepharitis treatment 1. It is also important to note that an eyelid tumor should be suspected in patients with atypical eyelid-margin inflammation or disease not responsive to medical therapy, and these patients should be carefully re-evaluated, as suggested in the blepharitis preferred practice pattern 1.
From the Research
Diagnosis of Chalazion
- A chalazion is a non-inflammatory process that develops due to retained secretion of the meibomian or Zeis glands, presenting as a mass lesion of the eyelids 2
- It is seen in all age groups and is one of the most common eye conditions 2
Treatment Options for Chalazion
- Treatment of choice differs among clinicians and may include:
- Application of warm compress onto eyelids
- Lid hygiene
- Using local antibiotic ointment with or without steroids
- Injecting steroid solution (triamcinolone acetonide) into the lesion
- Surgical removal of the lesion by incision and curettage 2
- Other experimented methods include:
- Injection of botulinum toxin A
- Tarsal trephination
- Removal of chalazion by application of CO2 laser or cryogenic action 2
Comparison of Treatment Options
- A prospective randomized treatment study compared three treatment options for chalazia: triamcinolone acetonide injections, incision and curettage, and treatment with hot compresses 3
- The study found that the resolution rates in the triamcinolone acetonide injection and surgical treatment groups were not significantly different from each other, but were significantly higher than the conservative treatment group 3
- Another study found that subcutaneous steroid injection is a simple and effective treatment for chalazion, with a complete resolution rate of 89.6% 4
Efficacy of Conservative Therapy
- A multicentre, randomized clinical trial found that hot compresses alone or in combination with tobramycin or tobramycin/dexamethasone drops and ointment are all effective first-line treatment options for chalazia 5
- However, the study also found that lesions that have been present for more than 2 months are less likely to resolve with conservative therapies alone 5
Comparison of Intralesional Corticosteroid Injection and Surgical Treatment
- A study compared the outcome of intralesional corticosteroid injection and surgical treatment of chalazia in pigmented patients, and found that intralesional steroid injection is an effective and safe alternative procedure for the treatment of chalazia 6
- The study also found that the results of intralesional steroid injection are comparable to surgical treatment, especially after a second injection 6