Chalazion

How a chalazion forms

Each eyelid has around 30 meibomian glands that secrete oil into the tear film. If a gland's opening blocks, oil backs up, the gland swells, and the trapped oil leaks into the surrounding lid tissue, where the body walls it off with a granuloma. The result is a firm nodule, a few millimeters to a centimeter across, within the lid rather than at its edge. It may start as a tender red swelling like a stye and become painless as the acute phase settles, or it may appear quietly.

Symptoms

A lump in the upper or lower lid, felt more than seen at first, then visible as a swelling; mild heaviness; and, with a large chalazion on the upper lid, pressure on the cornea that blurs vision by inducing astigmatism. Pain is mild or absent unless it becomes secondarily infected.

Treatment

• Warm compresses for ten minutes two to four times daily, followed by gentle massage toward the lid margin, for several weeks; this resolves most chalazia
• Lid hygiene to reduce the blepharitis that usually underlies it
• A steroid injection into the chalazion, which shrinks many within a couple of weeks and is done in the office in a minute
• Incision and drainage: under local anesthetic, the lid is everted, a small incision is made on the inner surface, and the contents are cleared; it takes a few minutes, needs no stitches and leaves no external scar
• Any chalazion that recurs in the same place, or looks unusual, is sent for examination under the microscope, because a rare eyelid tumor can mimic one

Preventing recurrence

Treat the meibomian gland dysfunction, blepharitis or rosacea behind it: regular warm compresses and lid cleansing, and, where indicated, a course of doxycycline or gland treatments such as thermal pulsation, where offered. Evidence on omega-3 supplements is mixed. Patients prone to chalazia find that a short daily routine prevents most of them.