Chalazion

Background

Anterior view of the right eye, with lacrimal duct shown medial.

• Chronic, sterile, granulomatous inflammatory lesion from blockage of a meibomian (or Zeis) gland
• Also known as meibomian gland lipogranuloma
• Often develops from a healing hordeolum (stye)
• More common on upper eyelid (higher density of meibomian glands)
• Risk factors: blepharitis, rosacea, seborrheic dermatitis

Clinical Features

Chalazion of right eye

• Eyelid swelling initially may be tender, evolving into a painless, rubbery, well-circumscribed nodule
• Not erythematous or warm (unlike acute hordeolum)
• Points toward conjunctival surface (can see on lid eversion)
• May cause astigmatism or visual disturbance if large enough to compress the cornea
• Key distinction from hordeolum: Chalazion is painless and chronic; hordeolum is acute, tender, and often has a pointing pustule

Differential Diagnosis

Periorbital swelling

Proptosis

• Normal IOP
  • Orbital cellulitis
  • Orbital pseudotumor
  • Orbital tumor
• Increased IOP
  • Retrobulbar abscess
  • Retrobulbar emphysema
  • Retrobulbar hemorrhage
  • Ocular compartment syndrome
  • Orbital tumor

No proptosis

• Periorbital cellulitis/erysipelas
• Dacryocystitis (lacrimal duct)
• Dacryocele/Dacryocystocele
• Dacryostenosis
• Dacryoadenitis (lacrimal gland)
• Allergic reaction
• Nephrotic Syndrome (pediatrics)

Lid Complications

• Blepharitis (crusts)
• Chalazion (meibomian gland)
• Stye (hordeolum) (eyelash folicle)

Other

• Subperiosteal abscess
• Orbital abscess
• Cavernous sinus thrombosis
• Conjunctivitis
• Contact dermatitis
• Herpes zoster
• Herpes simplex
• Sarcoidosis
• Granulomatosis with polyangiitis
• Sebaceous gland carcinoma: Consider in recurrent chalazia in the same location, especially in elderly patients — refer for biopsy

Evaluation

• Clinical diagnosis — no imaging or labs needed
• Evert eyelid to visualize the granuloma from the conjunctival side

Management

• Discontinue eye makeup and contact lenses until resolved
• Warm compresses × 15 minutes QID with gentle eyelid massage
• Antibiotics are NOT indicated (this is a granulomatous condition, not an infection)
• Eyelid hygiene with dilute baby shampoo scrubs
• Most resolve spontaneously over weeks to months
• Persistent cases: ophthalmology referral for intralesional steroid injection or incision and curettage

Disposition

• Discharge with warm compress instructions
• Ophthalmology referral if persistent >6 weeks, recurrent, or concern for malignancy

See Also

• Hordeolum
• Blepharitis
• Preseptal cellulitis