What is the recommended treatment for a chalazion in a child?

Chalazion Treatment in Children

Start with warm compresses (5-10 minutes, 3-4 times daily) combined with eyelid hygiene as first-line therapy for all pediatric chalazia, and escalate to intralesional triamcinolone injection after 4-6 weeks if conservative management fails. 1

Initial Conservative Management (First 4-6 Weeks)

• Apply warm compresses to the affected eyelid for 5-10 minutes, 3-4 times daily, to promote drainage of the obstructed meibomian gland 1
• Perform gentle massage of the affected area immediately 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
• Do not use topical antibiotics or steroids routinely, as recent pediatric evidence shows they do not decrease the odds of requiring procedural intervention compared to conservative measures alone 2

Treatment Escalation After 4-6 Weeks

Never continue conservative management beyond 4-6 weeks without reassessment, as this delays diagnosis of potential malignancy 1, 3

• Inject triamcinolone acetonide (5 mg/ml) directly into the lesion as the next step before surgery 1, 4
• Intralesional steroid injection achieves a 93.8% success rate compared to 58.3% with conservative management alone 1
• In pediatric studies, 75% of chalazia resolved after the first injection, with most remaining cases responding to a second injection 4
• Re-evaluate within a few weeks after injection to assess response and check intraocular pressure 1
• Common pitfall: Hypopigmentary skin changes can occur at the injection site, particularly with transcutaneous injections 1, 4

Surgical Management

Reserve incision and curettage for:

• Chalazia that fail intralesional steroid injection 4
• Large, recurrent, or multiple chalazia (consider combined incision, curettage, and intralesional steroid injection for 100% resolution rate) 4
• Infected chalazia 4

Critical Red Flags Requiring Immediate Ophthalmology Referral and Biopsy

Always biopsy chalazia with these features to exclude sebaceous carcinoma:

• Recurrence in the same location, especially in elderly patients 1, 3
• Marked asymmetry or resistance to standard therapy 1, 3
• Atypical features including eyelid margin distortion, focal lash loss, or ulceration 1, 3
• Unilateral chronic blepharitis unresponsive to therapy 1, 3

Pediatric-Specific Considerations

Children with chalazia require evaluation for chronic blepharokeratoconjunctivitis, which is often unrecognized and may present with recurrent conjunctivitis, keratitis, neovascularization, and eyelid inflammation 5, 1, 3

• Refer to ophthalmology if there is visual loss, moderate/severe pain, or severe/chronic redness 1
• Shorter pre-treatment chalazion duration correlates with lower risk of procedural intervention, so early aggressive conservative management is warranted 2

Addressing Underlying Conditions

Before treating the chalazion itself:

• Treat any associated bacterial blepharitis or meibomian gland dysfunction, as these are common predisposing factors 1, 3
• Evaluate for meibomian gland dysfunction, rosacea, or seborrheic dermatitis in patients with recurrent chalazia 1
• Institute regular eyelid hygiene for patients with blepharitis 1

Prevention Strategies

• Maintain regular eyelid hygiene for patients prone to recurrent chalazia, especially those with blepharitis or meibomian gland dysfunction 1, 3
• Treat underlying skin conditions such as rosacea or seborrheic dermatitis 1, 3
• Avoid eye makeup during active inflammation 1, 3

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 6, 1
• Low-energy IPL has been found effective and safe for treating moderate to severe blepharitis in children 6
• Use IPL with caution in darkly pigmented individuals (above Fitzpatrick skin type IV) due to risk of burns and pigmentation changes 6, 1