What is the best treatment for a patient with a chalazion, possibly with a history of blepharitis or meibomian gland dysfunction?

How to Treat a Bump on Your Eyelid (Chalazion)

Start with warm compresses and eyelid cleaning at home for 4-6 weeks—this works for most people and should be your first step. 1, 2

What You Need to Do at Home

Warm compresses (most important):

• Apply a warm, wet washcloth to your closed eyelid for several minutes, 1-2 times every day 1
• You can use hot tap water on a clean washcloth, a heat pack from the store, or a microwaveable rice/bean bag 1, 3
• Make sure it's warm but not hot enough to burn your skin 1, 3
• This helps melt the blocked oil and lets it drain out 1

Eyelid cleaning:

• After the warm compress, gently massage your eyelid in an up-and-down motion to help push out the blocked oil 1, 3
• Clean your eyelid margin using diluted baby shampoo or special eyelid wipes you can buy at the pharmacy 1, 3
• Hypochlorous acid 0.01% cleaners (available over-the-counter) work especially well because they kill germs 1, 3
• Do this every day 3

If you have crusty eyelids or a history of eyelid inflammation:

• Your doctor may add an antibiotic ointment like bacitracin or erythromycin to rub on your eyelid margins 1, 3
• This treats the underlying eyelid inflammation that may be causing your chalazion to keep coming back 1, 3

When Home Treatment Isn't Enough

If the bump doesn't go away after 4-6 weeks of doing everything above, you need to see your eye doctor for the next step. 2

Your doctor has two main options:

Option 1: Steroid injection

• A small injection of medicine (triamcinolone) directly into the bump 4
• Works about 84% of the time 4
• Less painful than surgery and more convenient 4
• Similar success rate to surgery 4

Option 2: Minor surgery

• The doctor makes a small cut and scoops out the blocked material 2, 5
• Works about 87% of the time 4
• Usually done from the inside of your eyelid so there's no visible scar 5
• More painful than the injection but still very effective 4

Important Warnings

See your doctor right away if:

• The bump keeps coming back in the same spot 1
• You're losing eyelashes where the bump is 1
• The bump looks very different from your other eyelid 1
• It doesn't respond to treatment 1, 6

These could be signs of eyelid cancer, which needs to be ruled out with a biopsy 1, 6

Special Situations

If you have ongoing eyelid inflammation (blepharitis):

• You need to keep doing eyelid hygiene every day forever, not just until the bump goes away 3
• This is a chronic condition that comes back if you stop treatment 3
• Your doctor may prescribe oral antibiotics like doxycycline if your eyelid inflammation is severe 3

If you have glaucoma:

• Don't press too hard on your eyelid during massage—this can increase eye pressure 1, 3

If your immune system is weak:

• You may need antibiotics sooner and closer monitoring 1

What to Expect

• Most chalazia resolve with home treatment if you're consistent 2
• Conservative treatment alone (just warm compresses) only works about 46% of the time, which is why adding proper eyelid hygiene and sometimes antibiotics is important 4
• If you need an injection or surgery, both work well—the injection is less painful and more convenient 4
• These bumps can come back, so keep up with daily eyelid hygiene even after it's gone 1, 3