Chalazion - Clinical Features & Management

A common eye disorder, a chalazion is a granulomatous inflammation of a meibomian gland in the upper or lower eyelid. This disorder is characterized by localized swelling and usually develops slowly over several weeks.
A chalazion may become large enough to press on the eyeball, producing astigmatism; a large chalazion seldom subsides spontaneously and may have to be incised and curetted surgically. A person susceptible to developing chalazia may have more than one because the upper and lower eyelids contain many meibomian glands. If a chalazion becomes persistent and chronic, a neoplasm should be ruled out by biopsy.

Pathophysiology:
Obstruction of the meibomian (sebaceous) gland duct causes a chalazion.

Signs and symptoms
A chalazion occurs as a painless, hard lump that usually points toward the conjunctival side of the eyelid. Eversion of the lid reveals a red elevated area on the conjunctival surface.

Diagnosis
Visual examination and palpation of the eyelid reveal a small bump or nodule. Persistently recurrent chalazia, especially in an adult, necessitate a biopsy to rule out meibomian cancer.

Treatment
Initial treatment involves applying warm compresses to open the lumen of the gland and, occasionally, instilling sulfonamide eyedrops. 

If such therapy fails or if the chalazion presses on the eyeball or causes a severe cosmetic problem, steroid injection or incision and curettage under local anesthetic may be necessary.
After such surgery, a pressure eye patch applied for 8 to 24 hours controls bleeding and swelling. After removal of the patch, treatment consists of warm compresses applied for 10 to 15 minutes, two to four times daily, and antimicrobial eyedrops or ointment to prevent secondary infection.

Special considerations
Instruct the patient how to properly apply warm compresses: Tell him to take special care to avoid burning the skin, to always use a clean cloth, and to discard used compresses