Chalazion

Chalazion is manifested by inflammation of the upper or lower eyelid. It is one of the most common ophthalmological disorders, and occurs when the secretion of sebaceous glands in the eye is blocked.

What is chalazion?

Chalazion is a chronic inflammation, but to understand how it occurs, we must first talk about the sebaceous glands, which are located in the eyelids.

We also talked about the secretion of the Meibomian gland in the article on dry eye syndrome. It produces oils, which later become part of the tear film, designed to:

  • Protect the eye from infection and trauma;
  • Protect against irritants (dust, wind, smoke);
  • Keep the eye moist.

When the Meibomian gland is blocked, the fluid no longer reaches the tear film but remains at the edge of the eyelid. The secretion is perceived as a foreign object by the body, so it triggers a local inflammatory reaction. This results in the appearance of several small benign tumor formations (inflammatory granulomas).

Other characteristics:

  • The size of the cysts varies from case to case;
  • Chalazion does not progress quickly. The disease develops in about 2 to 3 weeks;
  • It can occur in one or both eyes;
  • It can occur at any age, but is more common in young people (children and adolescents).

What causes the chalazion?

The main reason is blockage of the Meibomian gland. However, there are other factors that can also lead to the development of chalazion:

  • If the patient has previously experienced other inflammatory disorders: rosacea, seborrhea, acne;
  • If the patient has had an eyelid infection: conjunctivitis;
  • If the patient has experienced an inflammatory skin condition: seborrheic dermatitis;
  • If the patient has had a previous hordeolum (*more on this in the “Diagnosis” section);
  • If the patient has low immunity, hormonal imbalances;
  • If the patient has a form of diabetes;
  • Dust or lint collected at the base of the eyelashes can lead to blepharitis and subsequently to chalazion;
  • Rubbing the eyes frequently;
  • Poor eye hygiene.

How many types of chalazion are there?

Depending on the level of discomfort and the exact location of the chalazion, it can be of two types:

1. Internal chalazion

  • It forms in the back of the eyelid (conjunctival area);
  • Local swelling is almost invisible or absent (redness of the eye, local sensation of heat);
  • It appears as a small, congested cyst;
  • The pain intensifies under pressure.

2. External chalazion

  • It forms in the anterior part of the eyelid (skin area);
  • The swelling is visible to the naked eye;
  • It appears as a “rooster comb” – several lesions at the edge of the eyelid;
  • The external form of the disease is usually a consequence of the hordeolum.

What are the symptoms of chalazion?

Symptoms are not obvious from the start because the disorder is progressing slowly. However, here are some things you should pay attention to:

  • Inflammation of the eyelid – upper or lower;
  • Observation of small, hard on palpation cystic formations;
  • Eye redness;
  • Local stinging or pain;
  • Weakened visual acuity – sometimes granulomas can be so inflamed that they obstruct vision.

How can chalazion be diagnosed?

An ophthalmological consultation and a medical history are carried out to determine whether the patient has – or does not have – chalazion. If the answer is positive, the necessary treatment is determined, depending on the type and progression of the disease.

In the case of external chalazion, bacteriological investigations and antibiograms are also performed to determine which microbial agent caused the infection.

What is the difference between chalazion and stye?

Chalazion vs. Stye

Also in the eyelids, in addition to the Meibomian, there is another sebaceous gland: Zeiss. When this is obstructed, the patient experiences a stye. Another cause can also be infection of a hair follicle. In medical terms, the stye is also known as “hordeolum”.

Similarities: 

  • Both disorders can be internal or external.
  • Both disorders are caused by blocked sebaceous glands in the eyelids.

Differences:

  • In most cases, the stye is painful, while the chalazion is not.
  • Usually, chalazion occurs if you have experienced the hordeolum in the past.

During the ophthalmological examination, the exact disorder you have is determined and treated accordingly.

How is chalazion treated?

1. Spontaneous remission

There are situations where the disorder goes into remission on its own within a few weeks. This usually happens if the formation is small.

2. Conservative treatment

It involves applying local anti-inflammatories, such as warm compresses, to thin and drain discharges from the blocked glands.

Other recommendations:

    • Proper local hygiene and avoid touching the area with dirty hands;
    • Avoiding cosmetics and make-up;
    • Avoid wearing contact lenses during treatment. If absolutely necessary, single-use lenses should be worn;
    • Eyelid massage, 2-3 times a day;
    • Application of artificial tears to moisturize the eyes.
  • It is forbidden to squeeze the chalazion.

3. Antibiotics

On the doctor’s recommendation, they can be administered in the conjunctival sac:

  • Ophthalmic ointment;
  • Tobramycin and dexamethasone eye drops.

4. Injections

  • Injection of intra-lesional corticosteroids can speed up healing of the chalazion.

5. Chalazion surgery

If the chalazion doesn’t spontaneously heal, is bulky or doesn’t disappear after treatment, it can be surgically excised.

  • Through these incisions, the contents of the blocked gland are drained and the glandular sac is excised.
  • In the case of the internal chalazion, the incision is made vertically, perpendicular to the edge of the eyelid.
  • In the case of the external chalazion, the incision is made horizontally, parallel to the edge of the eyelid.
  • The procedure is performed under local anesthesia.
  • It’s minimally invasive. There are no sutures and the aesthetics of the eyelids are not affected in any way.
  • Post-operative risks are minimal. Eyelid ecchymosis (dark spots around the eyes) may occur, but disappears shortly after surgery.

6. Chalazion: Herbal treatment

It is not recommended to apply “old folk remedies”. Compresses moistened with various teas are not indicated in case of chalazion, as they could lead to aggravation of the disease or other infections.

What happens if you don't treat the chalazion?

Among the most common complications that can occur are:

  1. Astigmatism. This can be caused by the pressure the sclera puts on the cornea. This ophthalmic disease occurs in the upper eyelid.
  2. Eyelid phlegmon. The disorder can cause inflammation of the subcutaneous or connective cell tissue in the eye. Eyelid phlegmon can cause necrosis of the affected tissues.
  3. Eyelid cellulite. It is manifested by inflammation of cellular tissue and indurations that can cause persistent neuralgia.

Can chalazion reappear?

Yes. And that’s because there are a large number of sebaceous glands in the eyes and therefore, there’s a risk of them getting blocked.

However, there are ways you can prevent the occurrence of chalazion.

How can you prevent chalazion?

Have proper hand hygiene and avoid touching your eyes if they are dirty;

  • Avoid rubbing the eyelids;
  • Constantly disinfect your computer glasses, prescription glasses or contact lenses;
  • Check the expiry date of make-up and cosmetics and stop using them when they expire (e.g. creams, mascara, etc.);
  • Don’t put weight on the lash and eyelid area by over-applying makeup products;
  • Have an adequate local hygiene. Use eye wipes, special shampoo and warm water in the eye area;
  • Treats local disorders that may be causing it;
  • Do not share towels with other people;
  • Don’t borrow cosmetics or make-up products;
  • Change towels and pillowcases regularly;
  • If you swim, use underwater safety glasses.

If you are facing an eye disorder and need specialist advice, Dr. Holhos Ophthalmology Network is ready to provide you with the best care. State-of-the-art technology and positive reviews from other satisfied patients will convince you that you have made the best choice.

Text medically reviewed by Dr. Teodor Holhoș, Ophthalmic Surgeon
Written by Dr. Holhos Team
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