What is the treatment for a chalazion?

Treatment of Chalazion

The most effective treatments for chalazion are intralesional triamcinolone acetonide injection and incision and curettage, both showing resolution rates of 84-87%, significantly higher than conservative management with warm compresses alone (46%). 1

Definition and Diagnosis

A chalazion is a common eyelid lesion that develops due to retained secretion of the meibomian or Zeis glands. It is a non-inflammatory process that can occur in all age groups. 2

Diagnosis is typically based on:

• Clinical appearance of a localized eyelid mass
• History of gradual onset
• Absence of acute inflammatory signs (distinguishing it from a hordeolum) 3

Treatment Options

First-Line Conservative Management

• Warm compresses: Apply to affected eyelid for 10-15 minutes, 3-4 times daily 2
  • Most effective warm compress options:
    • Re-Heater device (best heat retention)
    • Hard-boiled egg (good heat retention and reusable)
    • Warm washcloths (less effective but commonly used) 4
• Eyelid hygiene: Regular cleaning of eyelid margins 2
• Topical antibiotic ointment: May be used with or without steroids 2

Second-Line Interventional Management

If conservative management fails after 2-3 weeks, consider:

1. Intralesional triamcinolone acetonide injection:

   • Dosage: 0.2 mL of 10 mg/mL solution
   • Benefits: 84% resolution rate, minimal pain, high patient satisfaction, less inconvenience 1
   • Follow with lid massage after injection 1

2. Incision and curettage:

   • Benefits: 87% resolution rate, high patient satisfaction 1
   • Limitations: Higher pain scores, greater patient inconvenience 1
   • For children: Consider lidocaine-prilocaine cream applied to the eyelid for 1 hour before local anesthetic injection to facilitate office-based management 5

Special Considerations

When to Suspect Malignancy

Biopsy should be considered for chalazia that:

• Are recurrent or persistent despite appropriate treatment 6
• Show atypical appearance or natural history 6
• Are unilateral and associated with conjunctival cicatricial changes 3
• Show marked asymmetry 3
• Have focal lash loss (ciliary madarosis) 3
• Cause loss of normal eyelid margin and conjunctival anatomy 3

Sebaceous carcinoma can masquerade as recurrent chalazia, particularly in elderly patients with unilateral, chronic, unresponsive blepharitis or conjunctivitis. 3

Cutaneous squamous cell carcinoma can also present as a chalazion-like lesion, though this is rare. 6

Treatment Algorithm

1. Initial approach: Conservative management with warm compresses, lid hygiene, and possibly topical antibiotics for 2-3 weeks 2, 1

2. If no improvement after 2-3 weeks:

   • For smaller, accessible lesions: Intralesional triamcinolone acetonide injection (0.2 mL of 10 mg/mL) 1
   • For larger lesions or those near the lacrimal punctum: Incision and curettage 1

3. For recurrent or atypical lesions:

   • Perform biopsy to rule out malignancy 6
   • Consider consultation with pathologist before biopsy if sebaceous carcinoma is suspected 3

4. For children:

   • Begin with conservative management
   • If surgical intervention is needed, consider lidocaine-prilocaine cream before local anesthetic to avoid general anesthesia 5