What are the treatment options for a patient with a chalazion, specifically for drainage?

Chalazion Treatment: Drainage and Management Options

For chalazion requiring intervention beyond conservative measures, incision and curettage (surgical drainage) combined with intralesional triamcinolone acetonide injection achieves 100% resolution and is the most effective approach, particularly for large, recurrent, or multiple chalazia. 1, 2

Initial Conservative Management

Before considering drainage, all chalazia should receive conservative treatment:

• Apply warm compresses to the affected eyelid for 10-15 minutes, 3-4 times daily to promote spontaneous drainage and accelerate resolution 1
• Institute regular eyelid hygiene measures, as chalazia are frequently associated with meibomian gland dysfunction or posterior blepharitis 1
• Conservative treatment alone (warm compresses, lid hygiene, topical antibiotics) achieves only 46% resolution at 3 weeks, significantly lower than interventional approaches 3

When to Proceed with Drainage

Drainage should be considered when:

• Chalazia persist despite 4 weeks of conservative treatment 4
• Large chalazia cause cosmetic deformity or functional impairment 1
• Multiple or recurrent chalazia are present 2
• The lesion fails to resolve spontaneously (most resolve on their own but can persist for months) 1

Drainage Options: Comparative Effectiveness

Option 1: Incision and Curettage PLUS Intralesional Steroid (RECOMMENDED)

• Achieves 100% resolution after 2 weeks with no recurrences or complications 2
• Combines mechanical drainage with anti-inflammatory effect
• Most appropriate for large, recurrent, and multiple chalazia 2
• Performed via transconjunctival incision followed by curettage and immediate intralesional triamcinolone acetonide injection 2

Option 2: Incision and Curettage Alone

• Achieves 75-87% resolution at 3 weeks 2, 3
• Recurrence rate of 22-26% within 6 months 4
• Higher pain scores compared to steroid injection alone 3
• Recommended specifically for infected chalazia 2
• Thermal cautery after drainage does NOT reduce recurrence rates (78% vs 74% no recurrence, not statistically significant) and should be left to practitioner discretion 4

Option 3: Intralesional Triamcinolone Acetonide Injection Alone

• Achieves 75-94% resolution depending on injection technique 2, 3, 5
• Subcutaneous extralesional injection (0.3 mL of 10 mg/mL) achieves 93.8% success versus 58.3% with conservative treatment 5
• Significantly less pain and patient inconvenience compared to surgery 3
• May require 2-3 injections for complete resolution 2
• Potential complications: yellow deposits at transcutaneous injection sites, hypopigmentary skin changes 2, 5
• Particularly useful for: children, patients with allergy to local anesthesia, chalazia close to lacrimal drainage system, and non-ophthalmologist physicians 2

Critical Red Flags Requiring Further Evaluation

Suspect malignancy (sebaceous carcinoma) and perform biopsy if: 6, 1

• Recurrence in the same location, especially in elderly patients 6
• Unilateral chronic blepharitis unresponsive to therapy 1
• History of multiple chalazion excisions at the same site 1
• Atypical features: nodular mass, ulceration, extensive scarring, lash loss (madarosis), localized crusting 6

Prevention Strategy

• Treat underlying meibomian gland dysfunction, rosacea, or seborrheic dermatitis in patients with recurrent chalazia 1
• Regular eyelid hygiene for patients with blepharitis 1
• Avoid eye makeup during active inflammation 1

Common Pitfalls to Avoid

• Do not rely on conservative treatment alone for chalazia that have persisted beyond 4 weeks—intervention is warranted 4, 3
• Do not assume thermal cautery reduces recurrence; it provides no additional benefit 4
• Do not dismiss recurrent chalazia in the same location without considering biopsy for sebaceous carcinoma 6
• Children with chalazia may have underlying chronic blepharokeratoconjunctivitis requiring ophthalmology evaluation 1