How is a chalazion typically managed?

Chalazion Management

Start with warm compresses (10-15 minutes, 3-4 times daily) combined with eyelid hygiene as first-line treatment for all chalazia, and escalate to intralesional triamcinolone acetonide injection (0.2 mL of 10 mg/mL) for persistent lesions, which achieves 84% resolution with less pain and inconvenience than surgery. 1, 2, 3

Initial Conservative Management

• 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 warm compresses to help express the obstructed meibomian gland 1
• Clean eyelid margins with mild soap or commercial eyelid cleansers as part of regular eyelid hygiene 1, 2
• Most chalazia resolve spontaneously with conservative management, though they can persist for months 2

Common pitfall: Patients often apply inadequate heat or insufficient duration—emphasize the full 10-15 minute application time for effectiveness.

Escalation for Persistent Chalazia

When conservative treatment fails after 3-4 weeks, proceed with:

• Intralesional triamcinolone acetonide injection (0.2 mL of 10 mg/mL) followed by lid massage achieves 84% resolution at 3 weeks, comparable to surgical excision (87%) but with significantly less pain and patient inconvenience 3
• Surgical incision and curettage remains highly effective (87% resolution) for lesions that fail steroid injection or are not amenable to injection 1, 3
• Intense pulsed light with meibomian gland expression shows promise as a non-surgical option for recurrent multiple chalazia 1

Red Flags Requiring Biopsy

Always consider sebaceous carcinoma in these scenarios:

• Recurrence in the same location, especially in elderly patients 1, 2, 4
• History of multiple chalazion excisions at the same site 2
• Marked asymmetry or resistance to therapy 1, 5
• Atypical features: eyelid margin distortion, lash loss (madarosis), or ulceration 1, 5
• Unilateral chronic blepharitis unresponsive to therapy 1, 2, 5

Critical pitfall: Sebaceous carcinoma can masquerade as a recurrent chalazion, and delayed diagnosis can be life-threatening—maintain a low threshold for biopsy in atypical cases. 4

Address Underlying Conditions

• Evaluate and treat meibomian gland dysfunction, rosacea, or seborrheic dermatitis in patients with recurrent chalazia 2
• Institute regular eyelid hygiene for patients with blepharitis or meibomian gland dysfunction to prevent recurrence 1, 2
• Children with chalazia may have underlying chronic blepharokeratoconjunctivitis requiring ophthalmology evaluation 2
• Advise avoiding eye makeup during active inflammation 2

Pediatric Considerations

• Conservative treatments remain first-line in children, though pediatric-specific efficacy data is limited 6
• Intralesional steroid injections demonstrate high success rates but carry risks of rare complications in children 6
• Surgical excision is effective for persistent lesions in pediatric patients 6
• Consider tailored approaches for underlying conditions such as vitamin A deficiency or Demodex infestation 6