Treatment for Chalazion
Start with conservative management using warm compresses for 5-10 minutes several times daily combined with eyelid hygiene, which resolves approximately 80% of chalazia without invasive intervention. 1, 2
Initial Conservative Approach
- Apply warm compresses to the affected eyelid for 5-10 minutes, 3-4 times daily, as this promotes spontaneous drainage of obstructed meibomian glands 1, 3
- Follow warm compresses with gentle massage of the affected area to help express the obstructed gland 1
- Clean eyelid margins with mild soap or commercial eyelid cleansers as part of regular eyelid hygiene 1
- Conservative therapy alone (lid hygiene and warm compresses) successfully resolves approximately 80% of chalazia without requiring invasive procedures 2
Escalation for Persistent Lesions
If the chalazion persists after 4-6 weeks of conservative management:
- Consider intralesional steroid injection (triamcinolone acetonide) for persistent chalazia, which demonstrates high success rates 1, 4
- Surgical incision and curettage remains the definitive treatment for chalazia that fail conservative and medical management 1, 4
- Intense pulsed light (IPL) with meibomian gland expression shows promise as a non-surgical option for recurrent multiple chalazia 1, 5
Critical Red Flags Requiring Biopsy
Any chalazion with the following features mandates biopsy to exclude sebaceous carcinoma:
- Recurrence in the same location, especially in elderly patients 1, 3, 5
- Marked asymmetry or resistance to standard therapy 6, 1
- Atypical features including eyelid margin distortion, focal lash loss (madarosis), or ulceration 1, 3
- Unifocal recurrent chalazia unresponsive to therapy 6, 1
- History of multiple excisions at the same site 3
The American Academy of Ophthalmology emphasizes that sebaceous carcinoma can masquerade as chalazion, and early recognition prevents disfigurement and can be lifesaving 6, 7. Before obtaining a biopsy for suspected sebaceous carcinoma, consultation with a pathologist is recommended to discuss potential need for frozen sections and special staining 6.
Address Underlying Conditions
- Evaluate and treat underlying meibomian gland dysfunction, rosacea, or seborrheic dermatitis in patients with recurrent chalazia 3
- Implement aggressive eyelid hygiene regimens for patients with chronic blepharitis to prevent recurrence 1, 3
- Treat any associated bacterial blepharitis prior to addressing the chalazion, as this is a common predisposing factor 6, 3
Pediatric Considerations
- Children with chalazia should be evaluated for chronic blepharokeratoconjunctivitis, which is often unrecognized and may present with recurrent conjunctivitis, keratitis, and eyelid inflammation 6, 5
- Refer to ophthalmology if there is visual loss, moderate/severe pain, or severe/chronic redness 5
- Conservative management remains first-line in children, though pediatric-specific efficacy data is limited 8
Common Pitfalls to Avoid
- Do not assume all eyelid nodules are benign chalazia—unilateral chronic blepharitis unresponsive to therapy may indicate underlying carcinoma 1, 3
- Avoid prolonged conservative management beyond 4-6 weeks without reassessment, as this delays diagnosis of potential malignancy 6, 7
- Do not use topical antibiotics routinely for uncomplicated chalazia, as they are non-inflammatory lesions caused by retained secretions rather than infection 4