What is the treatment for a chalazion on the eyelid?

Treatment of Chalazion

Start with warm compresses applied to the eyelid for 5-10 minutes, 3-4 times daily, combined with eyelid cleansing—this conservative approach is effective first-line therapy, though lesions present for more than 2 months are less likely to resolve and should proceed directly to intralesional steroid injection or incision and curettage. 1, 2

First-Line Conservative Management

Initial treatment should consist of:

• Warm compresses applied for 5-10 minutes, 3-4 times daily to soften meibomian secretions and promote drainage 3, 1
• Eyelid cleansing using diluted baby shampoo or commercially available eyelid cleaners on a cotton ball, cotton swab, or clean fingertip, performed once or twice daily 3, 1
• Gentle vertical massage of the eyelid after warm compresses to help express meibomian gland secretions 3

Important Technical Considerations

• Instruct patients to avoid compresses that are too hot to prevent skin burns 3
• Patients with advanced glaucoma should avoid aggressive eyelid pressure as it may increase intraocular pressure 3, 1
• Those with neurotrophic corneas require proper counseling to avoid corneal epithelial injury during cleansing 3, 1

Duration-Based Treatment Algorithm

The duration of the chalazion significantly impacts treatment success:

• Lesions present <2 months: Continue conservative therapy for 4-6 weeks, as these have higher resolution rates (mean pretreatment duration of 1.5 months for lesions that resolved versus 2.2 months for those that did not) 2
• Lesions present >2 months: Consider moving directly to more invasive therapies (intralesional steroid injection or incision and curettage), as older lesions are significantly less likely to resolve with conservative measures alone 2

Second-Line Medical Management

If no improvement after 2-4 weeks of conservative therapy:

• Topical antibiotic ointment (bacitracin or erythromycin) applied to eyelid margins one or more times daily for a few weeks 3, 1
• The addition of topical antibiotics (tobramycin) or combination antibiotic-steroid drops (tobramycin/dexamethasone) to warm compresses shows no significant advantage over warm compresses alone for complete resolution (21% vs 16% vs 18% respectively, p=0.78), though all three approaches reduce lesion size significantly 2

Third-Line Interventional Options

For persistent chalazia not responding to conservative and medical management:

• Intralesional steroid injection (triamcinolone acetonide) demonstrates high success rates but carries risks of rare complications 4, 5
• Incision and curettage remains effective for persistent lesions and is the definitive surgical option 4, 5, 2

Special Considerations

Evaluate for underlying conditions in recurrent cases:

• Consider screening for subclinical hypothyroidism in patients with recurrent chalazia, as thyroid dysfunction may predispose to recurrence 6
• Assess for vitamin A deficiency, Demodex infestation, or rosacea in refractory cases 5
• Rule out malignancy (sebaceous carcinoma) in cases of unifocal recurrent chalazia unresponsive to therapy, especially with asymmetric presentation, focal lash loss, or atypical features 3

Pediatric Modifications

• For children requiring oral antibiotics, use erythromycin 30-40 mg/kg divided over 3 doses for 3 weeks, then twice daily for 4-6 weeks, or azithromycin 5 mg/kg daily for 2 months 3
• Avoid tetracyclines in children under 8 years and women of childbearing age 3, 1

Common Pitfalls

• Do not continue conservative therapy indefinitely for lesions present >2 months—this delays definitive treatment 2
• Avoid long-term topical antibiotic use without intermittent breaks using different agents, as this promotes resistant organisms 3
• Do not overlook the possibility of sebaceous carcinoma in elderly patients with chronic unilateral, unresponsive "chalazia" 3