Should a chalazion be referred to dermatology or ophthalmology?

Chalazion Referral: Ophthalmology vs. Dermatology

Chalazia should be referred to ophthalmology rather than dermatology, as they are eyelid conditions that primarily affect the meibomian glands and are best managed by specialists in ocular structures. 1

Understanding Chalazia

Chalazia are distinct eyelid lesions characterized by:

• Gradual onset (unlike acute hordeola/styes)
• Usually painless presentation
• Firm, round nodule appearance
• Etiology involving retained secretions within the tarsus 1

Referral Decision Algorithm

Primary Care Management First

1. Initial management: Warm compresses and eyelid hygiene for 4-6 weeks
2. If no improvement after conservative treatment: Refer to ophthalmology

When to Refer to Ophthalmology

• Recurrent chalazia in the same location
• Large or persistent chalazia not responding to conservative treatment
• Chalazia causing visual disturbances
• Suspicion of malignancy (especially in elderly patients)
• Multiple recurrent chalazia in children (may indicate underlying conditions) 1, 2

Why Ophthalmology (Not Dermatology)

1. Specialized training: Ophthalmologists have specific training in eyelid structures and meibomian gland dysfunction
2. Procedural expertise: Ophthalmology departments routinely perform chalazion incision and drainage procedures 3
3. Diagnostic capabilities: Better equipped to rule out sebaceous carcinoma which can mimic chalazia 4
4. Management of complications: Can address potential ocular surface complications

Treatment Options in Ophthalmology Setting

Ophthalmologists can provide comprehensive management including:

• Evaluation of underlying ocular conditions
• Incision and curettage procedures when indicated
• Intralesional steroid injections
• Biopsy for suspicious lesions 5

Special Considerations

Children

• Children with recurrent chalazia should be evaluated by ophthalmology for:
  • Underlying chronic blepharokeratoconjunctivitis
  • Ocular rosacea
  • Ametropia (refractive errors) 2

Elderly Patients

• Recurrent chalazia in the same location in elderly patients require ophthalmology referral to rule out sebaceous carcinoma 4, 1

Efficacy of Treatment

• Surgical treatment by ophthalmology has a success rate of approximately 72%
• Conservative treatment resolves approximately 29% of selected chalazia 6

Potential Pitfalls

• Failing to recognize that untreated chalazia may indicate underlying conditions
• Missing sebaceous carcinoma which can masquerade as recurrent chalazia 4, 1
• Delaying referral for persistent chalazia, potentially leading to complications

While some dermatology practices may manage eyelid conditions, ophthalmology is the specialty with specific training in eyelid structures and meibomian gland dysfunction, making them the most appropriate specialists for chalazion management.