Chalazion Treatment
Start with conservative management using warm compresses and eyelid hygiene for 4 weeks, and if the chalazion persists, proceed to incision and curettage or intralesional steroid injection, as conservative treatment resolves only about one-third of cases while surgical treatment successfully treats approximately three-quarters of chalazia. 1
Initial Conservative Management
- Apply warm compresses to the affected eyelid for 5-10 minutes, several times daily 2
- Perform gentle massage of the affected area after applying warm compresses to help express the obstructed meibomian gland 2
- Clean eyelid margins with mild soap or commercial eyelid cleansers as part of regular eyelid hygiene 2
- Conservative treatment successfully resolves approximately 29% of chalazia within 3 months 1
- Continue conservative measures for 4 weeks before considering procedural intervention 3
When Conservative Treatment Fails
Topical antibiotics and steroids are not effective - a 2023 study found no decreased odds of requiring procedural treatment with initial topical antibiotics and/or steroids compared to conservative measures alone 4. The American Academy of Ophthalmology guidelines do not recommend routine topical medications for uncomplicated chalazia 5, 6, 2.
Procedural Interventions
Intralesional Steroid Injection
- Inject triamcinolone acetonide directly into the lesion for persistent chalazia 7
- This is a less invasive option than surgery and can be attempted before incision and curettage 2
- Re-evaluate within a few weeks to assess response and check intraocular pressure after corticosteroid treatment 5
Surgical Incision and Curettage
- Perform transconjunctival incision and drainage for chalazia that persist after 4 weeks of conservative treatment 3
- Surgical treatment successfully resolves approximately 72% of selected chalazia 1
- Thermal cautery is optional - a randomized study of 100 patients found no significant difference in recurrence rates between cauterized (78% success) and non-cauterized groups (74% success) 3
- The procedure is safe with infrequent complications that are generally easily managed 3
Advanced Treatment for Recurrent Cases
- Consider intense pulsed light (IPL) with meibomian gland expression for recurrent multiple chalazia as a non-surgical alternative 5, 2
- Evaluate for underlying conditions including meibomian gland dysfunction, rosacea, or seborrheic dermatitis in patients with recurrent chalazia 6, 2
- Treat underlying blepharitis or meibomian gland dysfunction with regular eyelid hygiene to prevent recurrence 6, 2
Critical Red Flags Requiring Biopsy
Biopsy is mandatory for the following presentations, as sebaceous carcinoma can masquerade as a chalazion:
- Chalazia recurring in the same location, especially in elderly patients 5, 6, 2
- Marked asymmetry or resistance to therapy 2
- Atypical features including eyelid margin distortion, lash loss (madarosis), or ulceration 6, 2
- Unilateral chronic blepharitis unresponsive to therapy 6, 2
- History of multiple excisions at the same site 6
The American Academy of Ophthalmology emphasizes that sebaceous carcinoma may be misdiagnosed as a chalazion, leading to delayed treatment, which significantly impacts mortality and morbidity 6.
Pediatric Considerations
- Refer children to an ophthalmologist if there is visual loss, moderate/severe pain, or severe/chronic redness 5
- Children with chalazia may have underlying chronic blepharokeratoconjunctivitis that is often unrecognized and requires specialist evaluation 5, 6
- The same treatment algorithm applies, but maintain a lower threshold for specialist referral 5
Cost-Effectiveness and Provider Considerations
- Nurse-led treatment of chalazion is safe, effective, and acceptable to patients with high satisfaction rates 1
- The marginal cost of nurse treatment (£9.91) is lower than physician treatment (£12.10) with equivalent outcomes 1
- Shorter pre-treatment chalazion duration correlates with lower risk of requiring procedural intervention 4