Treatment of Chalazion
Start with warm compresses applied for 10-15 minutes, 3-4 times daily, combined with eyelid hygiene; if the chalazion persists beyond 4-6 weeks of conservative therapy, proceed to intralesional triamcinolone acetonide injection (0.2 mL of 10 mg/mL) as it is nearly as effective as surgery but with less pain and inconvenience. 1, 2, 3
Initial Conservative Management (First-Line)
- Apply warm compresses to the affected eyelid for 10-15 minutes, 3-4 times daily to promote spontaneous drainage and accelerate resolution 1, 2
- Perform gentle massage of the affected area after applying warm compresses to help express the obstructed meibomian gland 1
- Institute regular eyelid hygiene by cleaning the eyelid margins with mild soap or commercial eyelid cleansers 1, 2
- Conservative therapy alone achieves complete resolution in approximately 18-21% of chalazia within 4-6 weeks, with mean size reduction of 1.2 mm 4
Critical caveat: Chalazia present for more than 2 months are significantly less likely to resolve with conservative therapy alone and should be considered for more invasive treatment earlier 4
Topical Medications (Optional Adjunct)
- Topical antibiotics (with or without steroids) may be added to warm compresses, though they do not significantly improve resolution rates compared to warm compresses alone 4
- The combination of warm compresses plus tobramycin/dexamethasone showed no statistical advantage over warm compresses alone (18% vs 21% complete resolution, p=0.78) 4
- Topical antibiotics are more appropriate for hordeolum (acute infection) rather than chalazion (non-inflammatory obstruction) 1, 5
Second-Line Treatment for Persistent Chalazia
- Intralesional triamcinolone acetonide injection (0.2 mL of 10 mg/mL) achieves 84% resolution rate at 3 weeks, comparable to surgical incision and curettage (87%) 3
- Steroid injection causes significantly less pain than surgery and is associated with less patient inconvenience while maintaining similar satisfaction scores 3
- Re-evaluate patients treated with corticosteroids within a few weeks to assess response and check intraocular pressure 6
Surgical Management
- Incision and curettage is reserved for chalazia that fail conservative management and steroid injection, or when immediate resolution is required 1, 3
- Surgical removal achieves 87% resolution but with higher pain scores and greater patient inconvenience compared to steroid injection 3
Advanced and Alternative Options
- Intense pulsed light (IPL) with meibomian gland expression shows promise for recurrent multiple chalazia as a non-surgical treatment option 1, 6
- Other experimental methods include botulinum toxin A injection, tarsal trephination, CO2 laser, and cryogenic treatment, though these lack robust evidence 5
Red Flags Requiring Further Evaluation
- Recurrence in the same location, especially in elderly patients, raises suspicion for sebaceous carcinoma and warrants biopsy 1, 2, 6
- Atypical features requiring biopsy include: eyelid margin distortion, lash loss (madarosis), ulceration, marked asymmetry, or resistance to therapy 1, 2, 6
- Unilateral chronic blepharitis unresponsive to therapy may be associated with carcinoma 1, 2
- History of multiple chalazion excisions at the same site should prompt consideration of biopsy 2
Prevention and Underlying Conditions
- Evaluate patients with recurrent chalazia for underlying conditions including meibomian gland dysfunction, rosacea, seborrheic dermatitis, or blepharitis 2
- Treat underlying skin conditions (rosacea, seborrheic dermatitis) to prevent recurrence 2
- Consider screening for subclinical hypothyroidism in patients with recurrent chalazia, as thyroid dysfunction may predispose to recurrence 7
- Avoid eye makeup during active inflammation 2
Pediatric Considerations
- Children with chalazia may have underlying chronic blepharokeratoconjunctivitis that requires evaluation by an ophthalmologist, particularly if there is visual loss, moderate/severe pain, or severe/chronic redness 6