Chalazion Treatment
The recommended first-line treatment for chalazion is daily eyelid hygiene with warm compresses and gentle massage of the eyelids to express the blocked meibomian glands. 1
Understanding Chalazion
- A chalazion is a cyst-like structure that forms when meibomian gland orifices become plugged, leading to retention of secretions 1
- Common contributing factors include meibomian gland dysfunction (MGD), posterior blepharitis, alterations in meibomian gland secretions, and seborrheic dermatitis or rosacea 1
- Chalazia can develop on either the upper or lower eyelid, causing localized swelling, redness, and mild discomfort 2
Treatment Algorithm
First-Line Treatment (Conservative Management)
- Warm compresses: Apply to the affected eyelid daily to help liquefy the thickened meibomian secretions 1, 3
- Eyelid hygiene: Clean the eyelid margins regularly to remove debris 1
- Gentle eyelid massage: Perform after warm compresses to express the blocked glands 1
- Conservative therapy alone has shown approximately 80% effectiveness in resolving chalazia 3, though more recent studies suggest a lower success rate of about 29% 4
Second-Line Treatment
- Topical corticosteroid ointments: May be applied if the condition persists despite conservative management to reduce inflammation 1
- Topical antibiotics: May be used in combination with warm compresses, though studies show no significant difference in outcomes between warm compresses alone versus warm compresses with antibiotics 5
Third-Line Treatment (For Persistent Chalazia)
- Intralesional steroid injection: Triamcinolone acetonide injection into the lesion 6
- Incision and curettage: Surgical removal of the lesion, which has shown success rates of approximately 72% 4
- Alternative methods: Include tarsal trephination, CO2 laser application, or cryotherapy 6
Special Considerations
- Chalazia that persist for more than 4 weeks despite conservative treatment warrant ophthalmological consultation 1
- Older lesions (>2 months duration) are less likely to resolve with conservative therapy alone and may require more invasive treatment 5
- Recurrent chalazia in the same location should raise suspicion for sebaceous carcinoma, especially in elderly patients 1, 7
- Biopsy should be considered for:
- Recurrent chalazia in the same location
- Marked asymmetry or resistance to therapy
- Atypical features such as eyelid margin distortion, lash loss, or ulceration 7
Pediatric Considerations
- Children with chalazia may have underlying chronic blepharokeratoconjunctivitis that requires evaluation by an ophthalmologist 2, 7
Follow-up
- Patients should return for follow-up if symptoms worsen 7
- For patients treated with corticosteroids, re-evaluation within a few weeks is recommended to assess response and check intraocular pressure 7