Chalazion Treatment
Begin with warm compresses applied for several minutes once or twice daily combined with eyelid hygiene and massage, and add topical antibiotic ointment (bacitracin or erythromycin) if there are signs of associated blepharitis. 1
Initial Conservative Management (First-Line)
The American Academy of Ophthalmology recommends starting all chalazion patients with conservative therapy before considering more invasive interventions 1:
Apply warm compresses to the affected eyelid for several minutes, once or twice daily, to soften meibomian secretions and promote drainage 1
- Use hot tap water on a clean washcloth, over-the-counter heat packs, or microwaveable bean/rice bags 1
- Instruct patients to avoid compresses hot enough to burn the skin 1
- Research shows hard-boiled eggs and specialized heat-generating devices may provide superior heat retention compared to washcloths 2
Perform eyelid hygiene concurrently with warm compresses 1:
Add topical antibiotics if signs of associated blepharitis are present 1:
Important caveat: Conservative treatment alone (warm compresses) shows only 46% resolution at 3 weeks compared to 84-87% with more aggressive interventions 4, so patients should be counseled that this approach requires patience and may ultimately fail.
When Conservative Management Fails (Second-Line)
If the chalazion persists after 2-4 weeks of conservative therapy, escalate to one of these options 1, 4:
Intralesional Steroid Injection (Preferred)
- Triamcinolone acetonide 0.2 mL of 10 mg/mL injected directly into the lesion 4
- Shows 84-93% resolution rate at 3 weeks 4, 5
- Significantly less pain and patient inconvenience compared to surgery 4
- Similar patient satisfaction to surgical treatment 4
- Risk: Potential for skin hypopigmentation at injection site 5
Incision and Curettage (Alternative)
- 87% resolution rate at 3 weeks 4
- Higher pain scores compared to steroid injection 4
- Greater patient inconvenience 4
- Reserve for cases where steroid injection fails or is contraindicated 4
Special Population Considerations
Patients with Blepharitis History
- Must treat the underlying blepharitis concurrently with long-term eyelid hygiene 1
- Consider oral antibiotics (doxycycline, minocycline, or tetracycline) if severe posterior blepharitis/meibomian gland dysfunction is present 3
- For women of childbearing age and children under 8 years, use oral erythromycin or azithromycin instead of tetracyclines 3
Immunocompromised Patients
- Require closer monitoring due to increased infection risk and slower resolution 1
- Benefit from earlier escalation to topical antibiotics 1
Patients with Advanced Glaucoma
- Counsel carefully to avoid aggressive lid pressure during warm compress application and massage, as this may increase intraocular pressure 1, 3
Critical Red Flags Requiring Biopsy
Biopsy is mandatory for 1:
- Atypical chalazia refractory to treatment
- Marked asymmetry between eyelids
- Unifocal recurrent chalazia
- Loss of normal eyelid margin anatomy
- Focal lash loss
- Conjunctival cicatricial changes
These signs may indicate sebaceous cell carcinoma or cutaneous squamous cell carcinoma 1.
Additional Considerations
Recurrent Chalazia
- Consider screening for subclinical hypothyroidism in patients with recurrent chalazia, as thyroid dysfunction may predispose to recurrence 6
- Treatment of underlying hypothyroidism may lead to remission 6