Chalazion overview © Michelle Baker This overview provides general information related to chalazion and does not take into account your personal circumstances
CHALAZION INFORMATION SHEET AN INFLAMMATORY LUMP IN THE OIL GLAND OF THE EYELID
Chalazion
TABLE OF CONTENTS What Is A Chalazion? What Are The Symptoms? What Is The Conservative Treatment For Chalazion? Conservative Treatment At Home Hot Boiled Egg Technique Victorian Hot Wooden Spoon Technique What Is The Medical Treatment For Chalazion? What Is The Surgical Treatment For Chalazion? Incison And Currettage (I&C) Intralesional Steroid Injection Does Diet Play A Role? Things To Remember How Can I Prevent Chalazion? Where Can I Get More Information On Chalazion?
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Chalazion
Where can I get more information on chalazion? 1. From your ophthalmologist (eye specialist) - Ask me! 2. Your optometrist or family doctor 3. Chalazion Case 4. Chalazion Evidence Based Information
WHAT IS A CHALAZION? A chalazion is an inflammatory lump or cyst in the eyelid caused by a blockage located at the tiny meibomian gland openings along the upper and lower eyelid margin. When the meibomian gland becomes blocked, it can rupture and the inflammation process begins. Each eyelid has approximately 27 of these sebaceous glands which secrete oil into the tear film to prevent evaporation of tears. Chalazion are more common if you have an eye condition called blepharitis or if you have eczema. Chalazia is the term for multiple chalazion. Chalazia may affect both upper and lower eyelids and can occur in both eyelids at the same time. A chalazion is not a stye; a stye is an infection at the base of an eyelash.
WHAT ARE THE SYMPTOMS? • a lump on the eyelid • redness, tenderness, swelling of the eyelid • vision may be slightly distorted if the lesion is large enough, usually on the superior eyelid (mechanical ptosis)
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Chalazion
WHAT IS THE CONSERVATIVE TREATMENT FOR CHALAZION? Chalazion usually resolve without surgical intervention. Patient’s presenting to the clinic for the first time are usually given a trial period of conservative treatment, as outlined below. A prospective randomised study found conservative treatment with hot compresses resulted in chalazion resolution in 46% of patients within three weeks.(1)
CONSERVATIVE TREATMENT AT HOME • Wash your hands with hot soapy water before you touch the eye area • “Can’t beat heat” - apply a hot compress over the eyelid lump e.g. a hot face-washer/disposable makeup pad/ hot boiled egg / Victorian hot wooden spoon technique or a heat pack as a hot compress for several minutes 4-6 times a day (re-warm as required). The heat will reduce the swelling by softening the oils in the blocked Meibomian gland. • Eyelid massage - immediately follow on with eyelid massage (upwards or downwards toward the eyelid margin as the Meibomian glands are oriented vertical in the eyelid), and this may improve drainage of your blocked oil gland. Massaging the eyelid can be performed with digital massage or with a cotton bud over the red lump. Chloramphenicol ointment, due to its lubricating effect, can be placed on a cotton bud or your finger tip prior to massaging the lump to decrease the irritation on the overlying skin. • Eyelid shampoo – treat any associated blepharitis with commercially available eyelid shampoo, eg. Sterilid foam cleanser. • Contact lenses should NOT be worn until the chalazion has resolved.
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Chalazion
HOT BOILED EGG TECHNIQUE
This method applies heat and pressure to the eye area by using a hot hard boiled egg. The hot whole shelled egg should be wrapped in a thin, dry cloth. As you wrap the egg with the cloth, gather the excess cloth in your fist to make a handle. The egg should fit well against the eye (use a small egg for children), and will hold the heat for about 30 minutes, long enough to watch a TV program. You can reheat the same egg in boiling water each time you plan to apply the warm compress. Do not reheat the egg using the microwave. Be careful, without the dry cloth, the egg will be extremly hot.
VICTORIAN HOT WOODEN SPOON TECHNIQUE
Heat can be applied to the eyelid by hot spoon bathing (or using a towel). The heat helps relieve the pain and helps the lump, or blocked meibomian gland, to self discharge. 1. Pad the end of a wooden spoon with an absorbent material such as gauze 2. Dip the spoon into a bowl of hot water 3. Keep the eyelid closed and put the padded spoon near the eyelid lump 4. As the spoon cools re-dip it into the boiling water and repeat 5. Repeat it for 10-15 minutes and do it four times daily until resolution.
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WHAT IS THE MEDICAL TREATMENT FOR CHALAZION? • Antibiotics are generally not indicated for chalazion. They may be indicated if you are at risk of infection or have multiple, recurrent chalazia with conditions such as ocular rosacea.
WHAT IS THE SURGICAL TREATMENT FOR CHALAZION • Surgical treatment can be considered for a persistent chalazion which has failed conservative treatment, if cosmetically disfiguring, including (Incision and Curettage) and/or intralesional steroid injection (Triamcinolone). Both procedures are usually performed under local anaesthesia. Children usually require a general anaesthetic.
INCISON AND CURRETTAGE (I&C)
Surgical drainage, termed Incision and Curettage, is a minor surgical procedure where a small incision is made on the roof of the gland and the contents of the gland(s) are scooped or curetted out. Risks of the operation include infection, bleeding, and damage to lid structures. The contents will be sent for histopathology examination. A study has found I&C resulted in chalazion resolution in 87% of patients.(1) Some types of chalazion are more ammenable to I&C compared to steroid injection and vice versa, and both treatments are sometimes concurrently indicated.(2) For instance a large or multi-loculated chalazia may respond best to a combination of I&C followed by intralesional steroid injection (injected while the chalzion clamp is still in situ as this limits steroid diffusion, allowing it to act effectively on any remaining granuloma).
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INTRALESIONAL STEROID INJECTION
Intralesional steroid injection with triamcinolone may be considered as an efficient, less invasive treatment for persistent chalazion in whom the chalazion diagnosis is straightforward and no biopsy is required. It is especially useful for cases with multiple chalazia or when chalazia are adjacent to the puncta (tear drainage apparatus), which could be damaged by surgery. Possible complications of steroid injection include ocular penetration, vision loss, raised intraocular pressure, subcutaneous fat atrophy and skin depigmentation, especially in darker-skinned patients. A prospective randomised study found a single intralesionsal injection, followed by eyelid massage, is as effective as I&C and resulted in chalazion resolution in 81% of patients, compared with 79% in the surgical, I&C group.(2)
DOES DIET PLAY A ROLE?
The role of diet in chalazia has long been studied, yet many questions remain. At this time, no dietary therapy has been demonstrated to the efficacious for chalazion.
THINGS TO REMEMBER
Contact me if you have: • Signs of infection such as increased eyelid redness, swelling or pain • Persistent, bothersome chalazion not resolving after 6-8 weeks as you may benefit from surgical treatment • Please note: atypical, persistent chalazion recurring in the same area may indicate a serious condition but this is rare.
HOW CAN I CHALAZION?
PREVENT
RECURRENCE
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• Treat blepharitis • Always wash your hands before touching your eyes. • Make sure that anything that comes in contact with your eyes, such as contact lenses or glasses, are clean. • If you have a pre-existing condition e.g. ocular rosacea which increases your chance of developing chalazion, antibitoics may be required.
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Chalazion
Even with appropriate treatment of chalazion, recurrence is common. It is difficult estimate the incidence however, as patients with resolution are often lost to follow up and chalazion can recur years after treatment. One study found that 22-26% of patients who have one chalazion treated with I&C developed recurrence during the course of a two-year follow up period.(3)
WHERE CAN I GET MORE INFORMATION ON CHALAZION? 1. 2. 3. 4.
From your ophthalmologist (eye specialist) - Ask me! Your optometrist or family doctor Chalazion Case Chalazion Evidence Based Information
References: 1. Goawalla, A, Lee, V. A prospective randomized treatment study comparing three treatment options for chalazia: triamcinolone acetonide injections, incision and curettage and treatment with hot compresses. Clin Exp Ophthalmol. 2007; 35(8):706 –712. 2. Simon, GB, Rosen, N, Rosner, M, Spierer, A. Triamcinolone Acetonide Injetion Versus Incision and Curettage for Primary Chalazia: A Prospective, Randomized Study. Am J Ophthal. 2011; 151:714718. 3. Sendrowski, DP, Maher, JF. Thermal Cautery After Chalazion Surgery and Its Effect on Recurrence Rates. Optom Vis Sci. 2000; 77(11): 605-607.
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