What is the treatment for a chalazion?

Treatment of Chalazion

The most effective treatment for chalazion involves a stepwise approach starting with warm compresses and lid hygiene, progressing to intralesional steroid injection or incision and curettage for persistent cases. 1, 2

First-Line Management

• Warm compresses applied to the affected eyelid for 5-10 minutes, several times daily, help increase blood circulation, promote drainage, and relieve discomfort 3, 4
• Eyelid hygiene with mild soap or commercial eyelid cleansers helps keep the area clean and prevents infection 3
• Gentle massage of the affected area after applying warm compresses helps express the obstructed meibomian gland 3
• Conservative therapy should be tried first but has lower resolution rates (46%) compared to more invasive options 5
• For optimal heat retention during warm compress application, reusable methods like hard-boiled eggs or commercial heat-generating products may be more effective than traditional warm washcloths 4

Second-Line Management

• Intralesional triamcinolone acetonide injection (0.2 mL of 10 mg/mL) followed by lid massage is highly effective with an 84% resolution rate 5
• Steroid injection causes less pain and inconvenience compared to surgical intervention while maintaining similar effectiveness 5
• Patients treated with steroid injections should be re-evaluated within a few weeks to assess response and check intraocular pressure 1

Third-Line Management

• Incision and curettage is indicated for chalazia that fail to respond to conservative treatment or steroid injection 5
• This surgical procedure has the highest resolution rate (87%) but is associated with more pain than steroid injection 5
• The procedure involves making a small incision in the conjunctival side of the eyelid and removing the contents of the chalazion 2

Special Considerations

• Chalazia that have been present for more than 2 months are less likely to resolve with conservative therapy alone and may benefit from earlier intervention with steroid injection or incision and curettage 6
• Recurrent chalazia in the same location should raise suspicion for sebaceous carcinoma, especially in elderly patients 1, 7
• Biopsy should be considered for chalazia that are recurrent in the same location, show marked asymmetry, are resistant to therapy, or have atypical features such as eyelid margin distortion, lash loss, or ulceration 1, 7
• Children with chalazia may have underlying 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 1

Treatment Algorithm

1. Start with conservative therapy (warm compresses, lid hygiene, gentle massage) for 4-6 weeks
2. If no improvement after 4-6 weeks or for chalazia >2 months old, proceed to intralesional steroid injection
3. If no response to steroid injection or for very large chalazia, perform incision and curettage
4. For recurrent chalazia in the same location, consider biopsy to rule out malignancy

Common Pitfalls

• Failing to distinguish between a hordeolum (acute infection) and chalazion (chronic, non-infectious inflammation) 3
• Missing underlying chronic blepharitis that predisposes to recurrent chalazia 3
• Not considering sebaceous carcinoma in cases of recurrent unilateral disease resistant to therapy 1, 7
• Attempting to "pop" the chalazion, which may spread inflammation 3