What is the treatment for chalazia?

Treatment of Chalazia

Start with warm compresses (5-10 minutes, 3-4 times daily) combined with eyelid hygiene as first-line treatment for all chalazia, and if there's no improvement after 4-6 weeks, proceed to intralesional triamcinolone acetonide injection before considering surgery. 1, 2

Initial Conservative Management (First 4-6 Weeks)

The American Academy of Ophthalmology recommends a stepwise approach beginning with conservative measures:

• Apply warm compresses to the affected eyelid for 5-10 minutes, 3-4 times daily to promote drainage of the obstructed meibomian gland 1, 2
• Perform gentle massage of the affected area immediately after warm compresses to help express the obstructed gland 1, 2
• Institute eyelid hygiene by cleaning the eyelid margins with mild soap or commercial eyelid cleansers 1, 2

Critical timing caveat: Do not continue conservative management beyond 4-6 weeks without reevaluation, as prolonging treatment may delay diagnosis of sebaceous carcinoma, particularly in older patients 1, 2

Treatment Escalation for Persistent Chalazia

Second-Line: Intralesional Steroid Injection

• Inject triamcinolone acetonide directly into the lesion as the next step for chalazia persisting after 4-6 weeks of conservative therapy 1, 2
• This approach achieves resolution in approximately 88% of non-infected cases, often with a single injection 3
• Re-evaluate within a few weeks after injection to assess response and check intraocular pressure 2
• Steroid injection is particularly suitable for:
  • Children and patients with allergy to local anesthetics 3
  • Chalazia located close to the lacrimal punctum 3
  • Patients who prefer to avoid surgery 3

Third-Line: Surgical Intervention

• Incision and curettage is indicated when steroid injection fails or for infected chalazia 3, 4
• Combined incision, curettage, and intralesional steroid injection achieves 100% resolution and is most effective for large, recurrent, or multiple chalazia 4

Addressing Underlying Conditions (Essential for Prevention)

Before treating the chalazion itself, address predisposing factors:

• Treat any associated bacterial blepharitis or meibomian gland dysfunction, as these are common predisposing factors 1, 2
• Evaluate for meibomian gland dysfunction, rosacea, or seborrheic dermatitis in patients with recurrent chalazia 1, 2
• Consider systemic antibiotics for severe underlying blepharitis 2
• Maintain regular eyelid hygiene for patients prone to recurrence 1, 2

Critical Red Flags: When to Biopsy

Always biopsy in these situations to exclude sebaceous carcinoma:

• Recurrent chalazia in the same location, especially in elderly patients 1, 2, 5
• Chalazia with marked asymmetry or resistance to standard therapy 1, 2
• Atypical features including eyelid margin distortion, focal lash loss, or ulceration 2
• Unilateral chronic blepharitis unresponsive to therapy 2

This is the most critical pitfall to avoid—prolonging treatment without considering malignancy in high-risk presentations 1

Emerging Treatment Options

• Intense pulsed light (IPL) with meibomian gland expression shows promise for multiple recurrent chalazia resistant to conventional therapy 1, 2, 5
• Use IPL with caution in individuals with darker skin pigmentation (Fitzpatrick type IV or above) due to risk of burns and pigmentation changes 1

Pediatric Considerations

• Children with chalazia should be evaluated for chronic blepharokeratoconjunctivitis, which often presents with recurrent conjunctivitis, keratitis, neovascularization, and eyelid inflammation 1, 2
• Refer to ophthalmology if there is visual loss, moderate/severe pain, or severe/chronic redness 2
• Intralesional steroid injection is particularly well-suited for pediatric patients as it avoids general anesthesia 3, 4

Special Considerations

• In patients with recurrent chalazia and subclinical hypothyroidism, treating the thyroid disorder may lead to remission 6
• Avoid eye makeup during active inflammation to prevent recurrence 2