Treatment of Chalazion
Begin with warm compresses applied for 10-15 minutes, 3-4 times daily, combined with eyelid hygiene as first-line therapy, as most chalazia resolve spontaneously with conservative management. 1, 2
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
- Clean eyelid margins with mild soap or commercial eyelid cleansers to address underlying meibomian gland dysfunction. 2
- Perform gentle massage of the affected area after warm compresses to help express the obstructed gland. 2
- Conservative therapy alone achieves approximately 80% resolution rates, though chalazia may persist for months. 3, 1
The evidence supporting conservative management is strong from guideline recommendations, though resolution may take weeks to months. This approach avoids procedural risks and should be attempted for at least 2-4 weeks before escalating treatment. 1, 3
Escalation to Intralesional Steroid Injection
For persistent chalazia after conservative management fails, intralesional triamcinolone acetonide injection (0.2-0.3 mL of 10 mg/mL) is the preferred next step, achieving 84-94% resolution rates with less pain and inconvenience than surgery. 4, 5
- Inject triamcinolone acetonide subcutaneously extralesionally via the percutaneous route. 4
- This approach demonstrates significantly higher success rates (93.8%) compared to conservative management alone (58.3%). 4
- Resolution rates with steroid injection (84%) are comparable to surgical incision and curettage (87%), but with significantly less pain and patient inconvenience. 5
- Re-evaluate patients within a few weeks after corticosteroid treatment to assess response and check intraocular pressure. 6
Important Caveat
- Potential complications include hypopigmentary skin changes at the injection site, though this occurs rarely. 4
Surgical Management
Reserve incision and curettage for chalazia that fail both conservative management and steroid injection, or for large lesions requiring immediate resolution. 1, 2
- Surgical excision achieves 87% resolution rates but causes significantly more pain than steroid injection. 5
- This remains definitive treatment when other methods fail. 7
Advanced Treatment Options
Intense pulsed light (IPL) with meibomian gland expression shows promise for recurrent multiple chalazia as a non-surgical alternative. 2, 6
Critical Red Flags Requiring Biopsy
Recurrence in the same location, especially in elderly patients, raises suspicion for sebaceous carcinoma and mandates biopsy. 1, 2, 6
Additional warning signs requiring further evaluation include:
- History of multiple chalazion excisions at the same site. 1
- Marked asymmetry or resistance to therapy. 2
- Atypical features: eyelid margin distortion, lash loss (madarosis), or ulceration. 1, 2
- Unilateral chronic blepharitis unresponsive to therapy. 1, 2
Prevention Strategies for Recurrent Cases
- Evaluate patients with recurrent chalazia for underlying meibomian gland dysfunction, rosacea, or seborrheic dermatitis. 1
- Institute regular eyelid hygiene for patients with blepharitis or meibomian gland dysfunction. 1, 2
- Treat underlying skin conditions (rosacea, seborrheic dermatitis). 1, 2
Pediatric Considerations
Children with chalazia may have underlying chronic blepharokeratoconjunctivitis that requires ophthalmology evaluation if there is visual loss, moderate/severe pain, or severe/chronic redness. 6