Chalazion Treatment
Initial conservative management with warm compresses and eyelid hygiene should be the first-line treatment for chalazion, with intralesional triamcinolone acetonide injection or incision and curettage reserved for lesions that fail to resolve after 3-4 weeks of conservative therapy. 1, 2
First-Line Conservative Management
Begin with warm compresses applied to the affected eyelid for 5-10 minutes, 3-4 times daily, to promote drainage of the obstructed meibomian gland. 1, 2 The evidence shows that warm compresses have approximately 46% resolution rate at 3 weeks, which is significantly lower than interventional approaches but avoids procedural risks. 3
- Perform gentle massage of the affected area after applying warm compresses to help express the obstructed gland. 1, 2
- Clean the eyelid margins with mild soap or commercial eyelid cleansers to reduce bacterial load and address underlying blepharitis. 1, 2
- Continue this regimen for 3-4 weeks before escalating to interventional treatment. 3
Interventional Treatment for Persistent Chalazia
If the chalazion persists after 3-4 weeks of conservative management, intralesional triamcinolone acetonide injection (0.2 mL of 10 mg/mL) is the preferred next step, as it achieves 84% resolution with less pain and inconvenience compared to surgery. 3 This represents the highest quality evidence comparing treatment modalities in a prospective randomized trial.
- Intralesional steroid injection followed by lid massage achieves similar efficacy to incision and curettage (84% vs 87% resolution) but with significantly less pain and patient inconvenience. 3
- Incision and curettage remains an alternative option with 87% resolution rate but causes more pain and inconvenience to patients. 3
- Both interventional approaches are significantly more effective than continued conservative management alone. 3
Management of Underlying Conditions
Address underlying meibomian gland dysfunction or blepharitis to prevent recurrence. 1, 4
- Regular eyelid hygiene is essential for patients with blepharitis or meibomian gland dysfunction. 1, 4
- Treat underlying skin conditions such as rosacea or seborrheic dermatitis. 1, 4
- Consider evaluation for subclinical hypothyroidism in patients with recurrent chalazia, as thyroid dysfunction may predispose to recurrence. 5
Critical Red Flags Requiring Biopsy
Any chalazion with atypical features requires biopsy to exclude malignancy, particularly sebaceous carcinoma or squamous cell carcinoma. 6, 1, 4
Perform biopsy when:
- Recurrence occurs in the same location, especially in elderly patients, as this raises suspicion for sebaceous carcinoma. 6, 1, 4
- Marked asymmetry, resistance to therapy, or unifocal recurrent chalazia that don't respond well to therapy. 6, 1
- Atypical features such as eyelid margin distortion, lash loss (madarosis), or ulceration are present. 1, 4
- Unilateral chronic blepharitis unresponsive to therapy, which may be associated with carcinoma. 6, 4
- History of multiple chalazion excisions at the same site. 4
Sebaceous carcinoma should be considered in elderly patients who have unresponsive, chronic, unilateral blepharitis or conjunctivitis, or recurrent chalazia. 6 This malignancy may have a multicentric origin and induce severe conjunctival inflammation due to pagetoid spread, making it difficult to diagnose. 6
Special Populations
Children with chalazia may have underlying chronic blepharokeratoconjunctivitis that requires evaluation by an ophthalmologist. 4 Chronic blepharokeratoconjunctivitis with recurrent hordeola is often unrecognized in children and requires prompt treatment to prevent complications. 2