Treatment of Chalazion
Begin with warm compresses applied for 5-10 minutes several times daily combined with eyelid hygiene, and if this fails after several weeks, proceed to intralesional triamcinolone acetonide injection (0.2 mL of 10 mg/mL) or surgical incision and curettage for persistent lesions. 1, 2
Initial Conservative Management (First-Line)
- Apply warm compresses to the affected eyelid for 5-10 minutes, several 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 as part of regular eyelid hygiene 1
- Most chalazia resolve spontaneously with conservative treatment, though they can persist for months 3
Important caveat: Conservative treatment with warm compresses alone shows only 46% resolution at 3 weeks compared to 84-87% with more aggressive interventions 2. If no improvement occurs within several weeks, escalate treatment rather than continuing indefinitely with compresses alone.
Advanced Treatment for Persistent Chalazia
When conservative measures fail after several weeks, two equally effective options exist:
Intralesional Steroid Injection (Preferred for patient convenience)
- Inject 0.2 mL of triamcinolone acetonide 10 mg/mL directly into the lesion 1, 2
- This achieves 84% resolution rate at 3 weeks with significantly less pain and patient inconvenience compared to surgery 2
- Re-evaluate within a few weeks to assess response and check intraocular pressure 4
- Patients report higher satisfaction and less inconvenience with this method compared to surgery 2
Surgical Incision and Curettage
- Achieves 87% resolution rate at 3 weeks, statistically equivalent to steroid injection 2
- Reserve for lesions that fail steroid injection or when injection is contraindicated 1
- Patients experience more pain with this approach compared to steroid injection 2
Emerging Non-Surgical Options
- Intense pulsed light (IPL) with meibomian gland expression shows promise specifically for recurrent multiple chalazia 1, 4
Critical Red Flags Requiring Biopsy
Always consider sebaceous carcinoma in these scenarios:
- Chalazion recurring in the same exact location, especially in elderly patients 1, 3, 4
- History of multiple excisions at the same site 3
- Marked asymmetry or resistance to standard therapy 1, 4
- Atypical features: eyelid margin distortion, loss of eyelashes (madarosis), or ulceration 1, 3, 4
- Unilateral chronic blepharitis unresponsive to therapy 1, 3
Prevention Strategies for Recurrent Cases
- Evaluate and treat underlying meibomian gland dysfunction, rosacea, or seborrheic dermatitis 3
- Maintain regular eyelid hygiene for patients with blepharitis or meibomian gland dysfunction 1, 3
- Consider evaluation for subclinical hypothyroidism in patients with recurrent chalazia 5
- Avoid eye makeup during active inflammation 3
Pediatric Considerations
- Children with chalazia may have underlying chronic blepharokeratoconjunctivitis that requires ophthalmology evaluation 3, 4
- Refer to ophthalmology if there is visual loss, moderate/severe pain, or severe/chronic redness 4
- Conservative treatments remain first-line in children, though pediatric-specific efficacy data is limited 6