What is the treatment for a chalazion?

Chalazion Treatment

The first-line treatment for chalazion consists of warm compresses applied to the affected eyelid for 5-10 minutes several times daily, combined with eyelid hygiene using mild soap or commercial eyelid cleansers. 1

Initial Conservative Management

• Apply warm compresses to the affected eyelid for 5-10 minutes, several times daily 1
• Clean eyelid margins with mild soap or commercial eyelid cleansers 1
• Perform gentle massage of the affected area after applying warm compresses to help express the obstructed meibomian gland 1
• Continue conservative treatment for 4-6 weeks, though complete resolution occurs in only about 18-21% of cases with conservative therapy alone 2
• Chalazia present for more than 2 months are less likely to resolve with conservative therapies and may require more invasive treatment 2

Advanced Treatment Options

For persistent chalazia that don't respond to conservative management:

• Intralesional steroid injection (triamcinolone acetonide) is recommended for persistent chalazia, with resolution rates of approximately 84% 3
• Incision and curettage is highly effective with resolution rates of about 87%, but may cause more pain than steroid injections 3
• Intense pulsed light (IPL) with meibomian gland expression shows promise as a non-surgical treatment option for recurrent multiple chalazia 4

Warning Signs Requiring Further Evaluation

• Recurrence in the same location raises suspicion for sebaceous carcinoma, especially in elderly patients 1, 4
• Marked asymmetry, resistance to therapy, or unifocal recurrent chalazia require further evaluation 1
• Atypical features such as eyelid margin distortion, lash loss, or ulceration necessitate biopsy 4, 5
• Unilateral chronic blepharitis unresponsive to therapy may be associated with carcinoma 1, 6

Special Considerations

• Children with chalazia may have underlying chronic blepharokeratoconjunctivitis that requires evaluation by an ophthalmologist 6, 4
• Recurrent chalazia may be associated with underlying conditions like meibomian gland dysfunction, rosacea, seborrheic dermatitis, or even subclinical hypothyroidism 6, 7
• Patients treated with corticosteroid injections should be re-evaluated within a few weeks to assess response and check intraocular pressure 4

Prevention Strategies

• Regular eyelid hygiene for patients with blepharitis or meibomian gland dysfunction 1, 6
• Treatment of underlying skin conditions (rosacea, seborrheic dermatitis) 6
• Avoiding eye makeup during active inflammation 6
• More aggressive eyelid hygiene regimen for patients with recurrent chalazia 1

Treatment Algorithm

1. First 4-6 weeks: Conservative management with warm compresses, eyelid hygiene, and gentle massage
2. If no improvement after 4-6 weeks: Progress to either intralesional steroid injection or incision and curettage
   • Choose steroid injection for less pain and inconvenience 3
   • Choose incision and curettage for slightly higher resolution rate 3
3. For recurrent chalazia: Consider biopsy to rule out malignancy, especially in elderly patients or with atypical features 4, 5
4. For multiple recurrent chalazia: Consider evaluation for underlying conditions and intense pulsed light therapy 4