What is the treatment for a chalazion?

Treatment of Chalazion

The primary treatment for chalazion begins with conservative management including warm compresses, lid hygiene, and topical antibiotics, but for persistent cases, intralesional steroid injection or incision and curettage are the most effective interventions. 1

Initial Conservative Management

• Apply warm compresses to the affected eyelid for 5-10 minutes, 3-4 times daily to help liquefy the meibomian gland secretions and promote drainage 2
• Perform regular eyelid hygiene to keep the area clean and prevent infection 1
• Consider topical antibiotic ointment with or without steroids, though evidence shows warm compresses alone may be equally effective 2

When to Consider More Invasive Treatment

• For chalazia that persist beyond 2 months despite conservative therapy 2
• For larger or symptomatic chalazia causing discomfort, cosmetic concerns, or visual disturbance 1
• For recurrent chalazia in the same location (which may warrant investigation for malignancy) 3

Procedural Treatment Options

Intralesional Steroid Injection

• Triamcinolone acetonide injection (4 mg) is effective for small chalazia (≤5 mm) 4
• Resolution rates of 87% have been reported with extralesional triamcinolone acetonide injection 4
• May require 1-2 injections for complete resolution 4
• Particularly useful for patients who wish to avoid surgery 1

Incision and Curettage

• Most effective treatment for persistent chalazia 5
• Performed under local anesthesia in adults 5
• For children, topical anesthesia with lidocaine-prilocaine cream can be applied prior to local anesthetic injection to minimize discomfort 6
• Procedure involves vertical incision through the conjunctival side of the eyelid and curettage of the chalazion contents 5

Advanced Treatment Options

• For recurrent multiple chalazia, intense pulsed light (IPL) with meibomian gland expression has shown promise as a non-surgical treatment option 3
• Other experimental methods include botulinum toxin A injection, tarsal trephination, CO2 laser application, or cryotherapy 1

Special Considerations

• Chalazia that recur in the same location should raise suspicion for sebaceous carcinoma, especially in elderly patients 3
• Biopsy should be considered for:
  • Recurrent chalazia in the same location 3
  • Marked asymmetry or resistance to therapy 3
  • Atypical features such as eyelid margin distortion, lash loss, or ulceration 3
• Children with chalazia may have chronic blepharokeratoconjunctivitis that is often unrecognized and should be evaluated by an ophthalmologist if there is visual loss, moderate/severe pain, or severe/chronic redness 3

Treatment Algorithm

1. Start with conservative therapy (warm compresses, lid hygiene) for 2-4 weeks 2
2. If no improvement after 2-4 weeks, consider:
   • For small chalazia (≤5 mm): Intralesional triamcinolone acetonide injection 4
   • For larger chalazia: Incision and curettage 5
3. For recurrent chalazia: Consider biopsy to rule out malignancy 3
4. For multiple recurrent chalazia: Consider IPL with meibomian gland expression 3

Follow-up

• Patients should return for follow-up if symptoms worsen 3
• For patients treated with corticosteroids, re-evaluation within a few weeks is recommended to assess response and check intraocular pressure 3