What are the treatment guidelines for a Chalazion?

Treatment Guidelines for Chalazion

First-Line Management

The first-line treatment for chalazion is warm compresses and eyelid hygiene, which should be initiated promptly upon diagnosis. 1

Warm Compress Application

• Apply warm compresses to affected eyelid for several minutes, 1-2 times daily
• Options for warm compresses include:
  • Clean washcloth with hot tap water
  • Commercial heat pack
  • Homemade bean/rice bag heated in microwave
  • The Re-Heater or hard-boiled egg (both show excellent heat retention) 2
• Important: Ensure temperature is comfortable to avoid skin burns

Eyelid Hygiene

• Gently cleanse eyelid margins to remove crusting
• Use diluted baby shampoo or commercial eyelid cleaner on a cotton ball/swab
• Hypochlorous acid 0.01% cleaners have strong antimicrobial effects 1

Second-Line Treatments

If conservative management fails after 4-6 weeks, consider:

Intralesional Steroid Injection

• Triamcinolone acetonide injection (0.2 mL of 10 mg/mL)
• Resolution rate of approximately 84% 3
• Advantages: Less painful and less inconvenient than surgical options
• Patient satisfaction comparable to surgical intervention 3

Incision and Curettage

• Surgical removal of the chalazion
• Resolution rate of approximately 87% 3
• More painful than steroid injection but highly effective 3
• Consider for larger or persistent chalazia

Special Considerations

Pediatric Patients

• Conservative treatment remains first-line in children
• Consider underlying conditions that may contribute to chalazion formation:
  • Vitamin A deficiency
  • Demodex infestation
  • Rosacea 4

Warning Signs Requiring Referral

• Recurrent chalazia in the same location
• Marked asymmetry of the lesion
• Resistance to therapy
• These may indicate sebaceous carcinoma, especially in elderly patients 1, 5
• Biopsy is indicated in these cases 1

Additional Considerations

• Antibiotic ointment (bacitracin or erythromycin) can be applied to eyelid margins 1+ times daily for a few weeks as needed 1
• Avoid aggressive eyelid manipulation in patients with advanced glaucoma or filtering procedures 1
• Children with recurrent chalazia may have unrecognized chronic blepharokeratoconjunctivitis requiring more aggressive treatment 1

Treatment Algorithm

1. Initial 4-6 weeks: Warm compresses + eyelid hygiene
2. If no improvement: Proceed to either:
   • Intralesional steroid injection (less painful, equally effective)
   • Incision and curettage (slightly more effective but more painful)
3. If recurrent or atypical: Refer to ophthalmologist for biopsy to rule out malignancy

Common Pitfalls

• Failing to recognize that untreated hordeola can progress to chalazia
• Using compresses that are too hot, risking skin burns
• Missing underlying sebaceous carcinoma in recurrent cases, especially in elderly patients
• Inadequate duration of conservative treatment before moving to invasive options