Treatment for Chalazion
Start with warm compresses applied for 5-10 minutes several times daily combined with eyelid hygiene as first-line therapy for all chalazia. 1, 2
Initial Conservative Management (First 4-6 Weeks)
The cornerstone of chalazion treatment involves mechanical measures to promote drainage of the obstructed meibomian gland:
- Apply warm compresses to the affected eyelid for 5-10 minutes, 3-4 times daily 1, 2
- Perform gentle massage of the affected area after warm compresses to help express the obstructed gland 1
- Institute eyelid hygiene by cleaning the eyelid margins with mild soap or commercial eyelid cleansers 1
- Consider topical antibiotics if there are signs of associated bacterial blepharitis, though evidence shows no significant benefit over warm compresses alone 3
Evidence Quality Note
A 2018 randomized trial of 149 patients demonstrated that warm compresses alone achieved 21% complete resolution, with no statistically significant difference when combined with topical antibiotics (16%) or antibiotic-steroid combinations (18%) 3. Chalazia present for less than 2 months are significantly more likely to resolve with conservative therapy compared to those present longer than 2 months 3.
When Conservative Treatment Fails
Do not continue conservative management beyond 4-6 weeks without reassessment, as this delays diagnosis of potential malignancy 1.
For persistent chalazia after 4-6 weeks of conservative therapy, escalate to:
Intralesional Steroid Injection
- Inject triamcinolone acetonide directly into the lesion as the next step before surgery 1, 4
- This approach shows high success rates with few complications 4
- Re-evaluate within a few weeks to assess response and check intraocular pressure 5
Surgical Incision and Curettage
- Reserved for chalazia that fail both conservative therapy and steroid injection 1
- Performed via transconjunctival approach with incision and drainage 6
- Thermal cautery during surgery does not reduce recurrence rates (78% vs 74% no recurrence at 6 months) and is left to practitioner discretion 6
Critical Red Flags Requiring Biopsy
Always biopsy chalazia with any of the following features to exclude sebaceous carcinoma:
- Recurrence in the same location, especially in elderly patients 1, 2, 5
- Marked asymmetry or resistance to standard therapy 1, 5
- Unifocal recurrent chalazia unresponsive to therapy 1
- Atypical features including eyelid margin distortion, focal lash loss, or ulceration 1, 5
- Unilateral chronic blepharitis unresponsive to therapy 2
The American Academy of Ophthalmology emphasizes that sebaceous carcinoma may masquerade as chalazion, and delayed diagnosis can be life-threatening 7.
Address Underlying Conditions
Treat any associated bacterial blepharitis or meibomian gland dysfunction before addressing the chalazion, as these are common predisposing factors 1:
- Evaluate for meibomian gland dysfunction, rosacea, or seborrheic dermatitis in patients with recurrent chalazia 2
- Institute regular eyelid hygiene for patients with blepharitis 7
- Consider systemic antibiotics for severe underlying blepharitis 7
Emerging Treatment Options
For recurrent multiple chalazia resistant to conventional therapy:
- Intense pulsed light (IPL) with meibomian gland expression shows promise as a non-surgical option 1, 5
- Vectored thermal pulsation therapy may improve meibomian gland function 7
Note that these technologies lack independent randomized controlled trials and are primarily fee-for-service treatments 7.
Pediatric Considerations
Children with chalazia should be evaluated for chronic blepharokeratoconjunctivitis, which is often unrecognized and may present with recurrent conjunctivitis, keratitis, neovascularization, and eyelid inflammation 7, 1, 5. Refer to ophthalmology if there is visual loss, moderate/severe pain, or severe/chronic redness 5.
Prevention Strategies
For patients prone to recurrent chalazia: