What is the treatment for a patient with a chalazion?

Treatment of Chalazion

Initial Conservative Management (First 4-6 Weeks)

Start all chalazia with warm compresses (5-10 minutes, 3-4 times daily) combined with eyelid hygiene, as this is the recommended first-line approach. 1, 2

• 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 3, 2
• Clean eyelid margins with mild soap or commercial eyelid cleansers as part of regular eyelid hygiene 3, 2
• Treat any underlying bacterial blepharitis or meibomian gland dysfunction before addressing the chalazion itself, as these are common predisposing factors 3, 2

Conservative Treatment Success Rate

• Conservative management resolves approximately 29-33% of chalazia within 3 months 4
• Most chalazia that will respond to conservative therapy do so within 4-6 weeks 2

Treatment Escalation for Persistent Chalazia

If the chalazion persists after 4-6 weeks of conservative therapy, proceed to intralesional steroid injection before considering surgery. 2

Intralesional Steroid Injection

• Inject triamcinolone acetonide (10 mg/mL, 0.3 mL) directly into the lesion via the percutaneous route 2, 5
• This approach achieves a 93.8% success rate compared to 58.3% with conservative management alone 5
• Re-evaluate within a few weeks after injection to assess response and check intraocular pressure 2
• Common pitfall: One case report documented hypopigmentary skin changes at the injection site, particularly in patients with multiple chalazia 5

Surgical Incision and Curettage

• Reserve surgery for chalazia that fail both conservative management and steroid injection 2
• Perform transconjunctival incision and drainage with curettage 6
• Surgical treatment successfully resolves approximately 72-74% of selected chalazia 6, 4
• Thermal cautery after surgery does not impact recurrence rates (78% vs 74% no recurrence at 6 months) and should be left to practitioner discretion 6

Critical Red Flags Requiring Biopsy

Always biopsy chalazia with any of the following features to exclude sebaceous carcinoma, which can masquerade as recurrent chalazia, especially in elderly patients: 7, 3, 2

• Recurrence in the same location, particularly in elderly patients 7, 3, 2
• Marked asymmetry or resistance to standard therapy 3, 2
• Unifocal recurrent chalazia unresponsive to therapy 3, 2
• Atypical features including eyelid margin distortion, focal lash loss, or ulceration 3, 2
• Unilateral chronic blepharitis unresponsive to therapy 3, 2
• History of multiple chalazion excisions at the same site 1

Do not continue conservative management beyond 4-6 weeks without reassessment, as this delays diagnosis of potential malignancy. 3, 2

Management of Underlying Conditions

Evaluate and Treat Predisposing Factors

• Assess for meibomian gland dysfunction, rosacea, or seborrheic dermatitis in patients with recurrent chalazia 1, 2
• Institute regular eyelid hygiene for patients with blepharitis or meibomian gland dysfunction 1, 2
• Consider systemic antibiotics for severe underlying blepharitis 2
• Emerging evidence: One case report suggests subclinical hypothyroidism may predispose to recurrent chalazia, with remission occurring after levothyroxine treatment 8

Emerging Non-Surgical Options for Recurrent Chalazia

• Intense pulsed light (IPL) with meibomian gland expression shows promise as a non-surgical option for recurrent multiple chalazia resistant to conventional therapy 7, 2
• IPL has demonstrated high Demodex eradication rates and improved meibum quality compared to topical treatments 7
• Caution: Use IPL with caution in darkly pigmented individuals (above Fitzpatrick skin type IV) due to risk of burns and pigmentation changes 7
• Vectored thermal pulsation therapy may improve meibomian gland function 2

Special Pediatric Considerations

• Children with chalazia should be evaluated by an ophthalmologist for chronic blepharokeratoconjunctivitis, which is often unrecognized and may present 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

Prevention Strategies

• Maintain regular eyelid hygiene for patients prone to recurrent chalazia, especially those with blepharitis or meibomian gland dysfunction 3, 2
• Treat underlying skin conditions such as rosacea or seborrheic dermatitis 3, 2
• Avoid eye makeup during active inflammation 3, 2