What is the treatment for a chalazion?

Chalazion Treatment

Start with warm compresses (5-10 minutes, several times daily) plus eyelid hygiene as first-line therapy for all chalazia; if no improvement after several weeks, proceed to intralesional triamcinolone acetonide injection, which is nearly as effective as surgery but less painful and more convenient. 1, 2

Initial Conservative Management

• Apply warm compresses to the affected eyelid for 5-10 minutes, multiple times daily 1
• Follow warm compresses with gentle massage of the affected area to help express the obstructed meibomian gland 1
• Clean eyelid margins with mild soap or commercial eyelid cleansers 1
• Conservative treatment alone achieves resolution in only 46% of cases at 3 weeks, significantly lower than interventional approaches 2

Interventional Treatment for Persistent Chalazia

For chalazia that persist beyond several weeks of conservative therapy, intralesional triamcinolone acetonide injection (0.2 mL of 10 mg/mL) is the preferred next step, achieving 84% resolution at 3 weeks with less pain and inconvenience than surgery 2

• Surgical incision and curettage achieves similar resolution rates (87%) but causes significantly more pain and patient inconvenience 2
• Intense pulsed light with meibomian gland expression shows promise as a non-surgical option for recurrent multiple chalazia 1
• Alternative experimental methods include botulinum toxin A injection, tarsal trephination, CO2 laser, or cryogenic treatment, though these lack consensus support 3

Key Clinical Distinctions

A chalazion presents as a painless nodule within the tarsal plate with gradual onset, visible meibomian gland obstruction on eyelid eversion, and association with blepharitis or meibomian gland dysfunction 4, 1

This contrasts sharply with a hordeolum (stye), which presents as a painful, erythematous nodule at the eyelid margin with rapid onset, acute inflammation, and often purulent discharge 1, 5

Critical Warning Signs Requiring Further Evaluation

Any chalazion with the following features warrants biopsy to exclude sebaceous carcinoma:

• Recurrence in the same location, especially in elderly patients 4, 1
• History of multiple excisions at the same site 4
• Marked asymmetry or resistance to therapy 1, 5
• Eyelid margin distortion, lash loss (madarosis), or ulceration 1, 5
• Unilateral chronic blepharitis unresponsive to therapy 4, 1

Sebaceous carcinoma is rarely misdiagnosed as chalazion, leading to delayed treatment, making vigilance for atypical features essential 4

Management of Underlying Conditions

Evaluate patients with recurrent chalazia for:

• Meibomian gland dysfunction requiring ongoing eyelid hygiene 4, 1
• Rosacea or seborrheic dermatitis needing specific treatment 4, 1
• Subclinical hypothyroidism, which may predispose to recurrent chalazia and respond to levothyroxine 6
• In children, chronic blepharokeratoconjunctivitis requiring ophthalmology referral 4

Prevention Strategies

• Maintain regular eyelid hygiene for patients with blepharitis or meibomian gland dysfunction 4, 1
• Treat underlying skin conditions (rosacea, seborrheic dermatitis) 4, 1
• Avoid eye makeup during active inflammation 4, 1

Natural History

Most chalazia resolve spontaneously but can persist for months 4. Cosmetic deformity of the eyelid is a potential complication 4. The condition can develop on either upper or lower eyelid and may cause localized swelling, redness, and mild discomfort 4.