Chalazion
Chalazion
Overview
A chalazion (also known as meibomian cyst) is a common condition. It is an inflamed swelling in the eyelid caused by a blocked oily duct. The meibomian glands are in the tarsal plates of the eyelids and contain over 25 tiny oily secreting ducts per eyelid which open onto the eyelid margin and secrete oil into the tear film, which helps stop tears evaporate. If just one duct gets blocked, oil accumulates and the body reacts by sending in inflammatory cells which cause a red painful inflamed lump.
Natural history
A chalazion may eventually settle with antibiotic ointment applied regularly onto the eyelid margin for two weeks and hot compresses used if very inflamed. This may leave a quiet noticeable lump which needs surgery.
This picture shows an inflamed chalazion lower lid and blepharitis (crusting and redness at the lashes). There is also an infected lash follicle (small stye).
Picture of a quiet chalazion in the upper lid.
Other cysts can occur around the eyelids such as watery cysts of Moll which are accumulations of sweat fluid in a skin cyst. Cysts of Moll are removed via small skin incisions under local anaesthesia.
Examination of your eyelids
Before the oculoplastic surgeon decides on surgery they will examine your eyes and evert your eyelid. Whilst this is being done, you should keep your eyes open and look down, then it doesn’t hurt.. The chalazion has a typical “grey” appearance of the other side of the eyelid, which helps confirm the diagnosis.
Look down.
The doctor gently holds the eyelashes and pulls the lid a tiny bit and uses a cotton bud / Q-tip or similar to flip the eyelid.
Typical grey appearance is seen on the under surface of the eyelid
Surgery – incision and curettage (I+C)
If the chalazion doesn’t settle, it may require surgery to drain the contents. This simple surgery is done under local anaesthesia. First the skin is cleaned then a drop of local anaesthetic inserted on the surface of the eye.
Local anaesthetic is injected into the eyelid beneath the skin around the chalazion.
A small clamp is placed and a blade used to incise the chalazion from the under surface of the eyelid.
Old inflammatory debris is drained from the cyst and the cavity curetted.
An empty clean duct is left after I+C.
Post-operative care
- Antibiotic ointment is placed on the eye then a firm dressing of two eye pads for a minimum of 20 minutes and up to 24 hours.
- You should continue the antibiotic ointment is continued three times a day for 5 days.
- You should not drive for 48 hours after your surgery. You should have someone accompany you home.
- Your eyelid will be slightly red and swollen for a few days
- You should not swim for at least one week
- If you wear contact lenses, do not put them back in for one week, until the eye feels completely healed.
- If the eyelid is very inflamed, used icepacks to reduce swelling.
Frequently Asked Questions
- What if I don’t want surgery for my chalazion?
You don’t have to have surgery. There is a very good chance that with time (6 – 9 months) the lump will gradually settle and disappear. Surgery helps it disappear quickly.
Alternative treatments: injection of a small amount of steroid into the eyelid around the lump to quieten the inflammation and help it settle faster.
- When is my chalazion not suitable for I+C?
If the chalazion is already getting better and there is just a very small lump that doesn’t look as though it contains anything to drain..
- Will I get the chalazion back again?
It is unlikely that you will get that chalazion back again, but you still have over 20 other meibomian ducts in each eyelid which could become blocked and cause a new chalazion in the future.
- What are the risks of surgery?
Common risks include localised bruising and swelling post-operatively. There is a very low risk of infection. These are the reasons an eyepad is commonly placed and antibiotic cream used.
Theoretically there is a risk of inadvertent eye perforation from the local anaesthetic needle; this is extremely rare.
- How can I prevent getting another chalazion in the future?
People with a chalazion often have blepharitis and this should be treated well.
- Could my lump be anything more serious?
Rarely an inflamed lump on the eyelid is a small cancer such as a rodent ulcer or basal cell carcinoma, but this originates from the skin and won’t be visible under the eyelid when it is everted. Another skin tumour called squamous cell carcinoma can cause an ulcerated lump, but this is again from the skin.
Rarely, there is a meibomian cell carcinoma (sebaceous cell carcinoma) which looks like a like a chalazion when small but is a malignant cancer. If you have a “chalazion” which required I+C more than once exactly in the same place, especially if it doesn’t drain any debris, a carcinoma should be considered a possibility and a BIOPSY taken by the surgeon for the cells to be examined. One or two other very rare tumours can also mimic chalazia.