CHALAZIONChalazion is a chronic noninfective inflammation of the sebaceous glands of the eyelid. They commonly affect the meibomian glands in the tarsal plate, resulting clinically as a painless, firm nodule of the eyelid. Marginal chalazia are caused by inflammation of the gland of Zeis located at the lid margin. They can affect both the upper and lower lids.Acne rosaceaand posterior blepharitis are commonly associated with chalazion. Hyperimmunoglobulinemia E (Job syndrome) can be associated with aggressive chalazion.Meibomitis predisposes to chalazion formation. Meibomitis causes blockage of the meibomian orifices and clogging of the glands with secretions. This result in swellings in the eyelid called chalazion and hardening of secretions with time. Chalazion is a noninfective condition. However, it can become infected and acutely inflamed, causing a tense, warm lid swelling called hordeolum internum. This is how meibomitis is linked to the pathogenesis of chalazion formation and recurrence.Histologically, deep dermal or subcutaneous suppurative lipogranulomatous inflammation exists, containing neutrophils, plasma cells, lymphocytes, histiocytes, and giant cells in a zonal configuration around central lipid material. A pseudocapsule surrounds the cellular infiltrate.[1]Many chalazia resolve within 2 weeks of a topical antibiotic and steroid medication and application of warm compresses.[2]These aid in reducing inflammation and increasing the local blood supply.Incision and curettage is a conventional and effective treatment of chalazion (see the image below).[2, 3]In cases of multiple chalazia with no evidence of infection, local intralesional injection of triamcinolone may cause regression of the chalazion within a few weeks.[4]It can also be used as an alternative to standard surgical procedure.[5]IndicationsIndications for chalazion procedures include the following: A large chalazion A chalazion that does not respond to conservative management Multiple chalazia A chalazion causing significant astigmatic refractive error due to mechanical effects on the cornea[6]ContraindicationsInflamed chalazion (hordeolum internum) is an absolute contraindication.AnesthesiaTopical tetracaine is added to the eye and cul de sac, and 1-1.5 mL of lidocaine with 1:1, 00,000 epinephrine are injected beneath the orbicularis muscle through the skin route over the chalazion site.EquipmentEquipment used in chalazion procedures includes the following: 30-gauge needle mounted on a 2-cc syringe loaded with anesthetic mixture as described. Chalazion clamp and scoop No. 15 Bard Parker blade/radiofrequency cautery tip with unit Vannas scissors (optional) Cotton-tipped applicators and dressing material. Single-tooth forceps

ComplicationsPotential complications of chalazion procedures are as follows: Bleeding Lid notching due to incision to lid margin Tarsal plate instability due to too large incisions Recurrences Inadvertent ocular traumaLocal intralesional injection of triamcinolone may result in hypopigmentation at the site of injection, atrophy of the tarsal plate, visible depot of the medication, and/or a raise in intraocular pressure.Postoperative CarePostoperatively, an antibiotic and steroid drop or ointment and lubricants are prescribed to the eye for 1 week. Initially, cold compresses are applied for 48 hours, and then warm compresses are continued several times a day. In cases of recurrent or multiple chalazia, a course of oral tetracyclines is prescribed for 1 month (Doxycycline 100 mg twice a day for 1 week followed by 100 mg once a day for 3 weeks). A chalazion is usually a self-limiting condition with excellent prognosis. However, the patient is instructed to follow regular lid hygiene measures and control of meibomitis.PrognosisPrognosis is excellent.

BackgroundFocal swelling of the eyelid is a common complaint in both primary care and urgent care settings. Often, such swelling is identified as either a chalazion, appearing as a characteristically hard and painless lid nodule, or ahordeolum(stye), although several other benign and malignant processes can be mistaken for these two.[1]Chalazia (plural of chalazion), which are the most common inflammatory lesions of the eyelid, are slowly enlarging eyelid nodules, formed by inflammation and obstruction of sebaceous glands. Chalazia can be categorized as either superficial or deep, depending on the glands that are blocked. Inflammation of a meibomian gland leads to a deep chalazion, whereas inflammation of a Zeis gland leads to a superficial chalazion. Chalazia can recur, and those that do should be evaluated for malignancy.PathophysiologyChalazia form when lipid breakdown products, possibly from bacterial enzymes or retained sebaceous secretions, leak into surrounding tissue and incite a granulomatous inflammatory response.[2]Since meibomian glands are embedded in the tarsal plate of the eyelids, edema due to blockage of these glands is usually contained on the conjunctival portion of the lid; on occasion, a chalazion may enlarge and break through the tarsal plate to the external portion of the lid. Chalazia due to blockage of Zeis glands are usually located along the lid margin.Chalazia differ from hordeola in that they form as a result of gland obstruction and sterile inflammation rather than infection. Whereas a chalazion is characterized by a mass of granulation tissue and chronic inflammation (with lymphocytes and lipid-laden macrophages), an internal or external hordeolum is primarily an acute pyogenic inflammation with polymorphonuclear leukocytes (PMNs) and necrosis with pustule formation.In general, chalazia tend to be larger, less painful and have a less acute presentation than hordeola.[3]However, one condition can result in the other. The acute inflammation of a hordeolum may eventually lead to a chronic painless chalazion, while a chalazion can also become acutely infected.EtiologyChalazia occur after gland blockage, which can be associated with the following: Poor lid hygiene (the precise causal role has not yet been established) Seborrheic dermatitis Acne rosacea Chronic blepharitis High blood lipid concentrations (possible risk from increased blockage of sebaceous glands) Leishmaniasis Tuberculosis Immunodeficiency Viral infection Carcinoma Stress (causality has not been proven, and the mechanism by which it might act is unknown)As noted (see Pathophysiology), a chalazion may arise spontaneously subsequently to the development of an internal hordeolum.EpidemiologyUnited States and international statisticsChalazia are common, but their exact incidence and prevalence in the United States are not known. Data about the worldwide prevalence or incidence of chalazia are also unavailable.Age-related demographicsAlthough chalazia occur in all age groups, they are more common in adults (especially those aged 30-50 years) than in children, presumably because androgenic hormones increase sebum viscosity. Hormonal influences on sebaceous secretion and viscosity may explain clustering at the time of puberty and during pregnancy; however, the large number of patients without evidence of hormonal alteration suggests that other mechanisms also apply. Chalazia are uncommon at the extremes of age, but pediatric cases may be encountered.Recurrent chalazion, particularly in elderly patients, should prompt the practitioner to consider conditions that may masquerade as a chalazion (eg, sebaceous carcinoma, squamous cell carcinoma, microcystic adnexal carcinoma, tuberculosis). Recurrent chalazion in a child or young adult should prompt an evaluation for viral conjunctivitis and hyperimmunoglobulinemia E (hyper-IgE) syndrome (Job syndrome).Sex- and race-related demographicsChalazia appear to affect males and females equally, but as noted, precise information about prevalence and incidence is not available. Contrary to popular opinion, research has not shown that the use of eyelid cosmetic products either causes or aggravates the condition.No information about prevalence or incidence with respect to race is available.PrognosisConservative management facilitates resolution of chalazia, and patients receiving therapy usually have an excellent outcome. Untreated chalazia occasionally drain spontaneously but are more likely to persist with intermittent acute inflammation compared to treated chalazia. When untreated, new lesions often develop, and inadequate drainage may result in local recurrences, especially if a predisposing skin condition is present.Morbidity associated with chalazia may include the following: Acute inflammatory exacerbation can lead to an anterior (through the skin) or a posterior (through the conjunctiva) rupture, forming a granuloma pyogenicum Persistent drainage and swelling can cause irritation to the eye Progression of a chalazion can lead to a disfiguration of the eyelids; continued inflammation could also lead to apyogenic granuloma Chalazia can predispose topreseptal cellulitis, especially in individuals with atopy Large, centrally located chalazia can cause visual disturbances by pressing on the cornea, causing mechanical with-the-rule astigmatism; acquired hyperopia and decreased vision have also been reported with chalazia of the upper eyelid[4]Patient EducationThe clinician should ensure that patients have an adequate understanding of the typical progression of an uncomplicated chalazion, that is, resolution within a few weeks to a few months. Patients should receive instructions regarding the importance of adequate lid hygiene and general health measures (eg, rest, stress management, proper diet) to maintain good skin function. The clinician should explain that although the lesions are benign, meticulous lid hygiene and dedication may be required as curative and preventive measures.The following measures (in decreasing order of importance) should be recommended: Gentle but firm and vigorous massages to promote drainage of the obstructed gland (with care taken not to rupture the chalazion) Application of warm compresses to help melt the viscous lipids Use of water and baby shampoo, which does not sting if it gets into the eye, to remove the secretions collecting on the margins of the lidsMore complex procedures may be preferred. An example is the use of diluted baby shampoo on a cotton wool applicator to rub along the mucocutaneous junction and gray line of the lid. However, methods such as this one do not promote adequate drainage of the glandular secretions; they are also cumbersome and difficult, and additional paraphernalia are required.For patient education resources, see the Eye and Vision Center, as well as Chalazion (Lump in Eyelid) and Sty.HistoryA chalazion is usually a painless swelling on the eyelid that has been present for weeks to months. Patients may seek medical attention only when the condition worsens, as when a chalazion causes impaired vision or discomfort or becomes inflamed, painful, or infected. Frequently, there is a long history of previous similar occurrences because chalazia tend to recur in predisposed individuals.The chief complaint must be examined thoroughly, including questions regarding the location of the lesion, its onset, duration, intensity, and exacerbating and mitigating factors, as well as previous interventions and evaluations. If the chalazion is recurrent, the patient should be asked how often it has occurred before and if the new lesion is in the same location as a previous one.As intercontinental travel becomes easier, it is increasingly important to inquire into the patients history of travel, particularly to regions known to be endemic for tuberculosis andleishmaniasis.[5]The following should be documented: Any changes in visual acuity Any recent viral infections Immunocompetence Any history of frequent skin infections Any exposure to or history of tuberculosis[6] Any personal history of cancer[7]Symptoms such as eye pain, acute visual changes, fever, limitation of extraocular movement, and diffuse eyelid swelling point to a diagnosis other than a chalazion.Physical ExaminationA complete examination of the eye and of the conjunctival surface should be carried out. A chalazion takes the form of a palpable nodule on the eyelid, sometimes as large as 7-8 mm in diameter. Usually, it is firm, nonerythematous, nonfluctuant, and nontender, although a large chalazion may be tender as a consequence of size effects. Chalazia are more common on the upper lid (see the image below) than on the lower lid because of the increased number and length of meibomian glands present in the upper lid.Chalazion. Image courtesy of Larry Stack, MDPhysical features help distinguish a chalazion from a hordeolum. Patients with the former generally have a single firm nontender nodule (or, in rare cases, multiple nodules) located deep within the lid or the tarsal plate, whereas patients with the latter have a more superficial and painful lesion that is typically centered on an eyelash.The eyelid should be everted to allow visualization of the palpebral conjunctiva and to identify an internal chalazion (see the image below).Chalazion with eyelid everted. Image courtesy of Larry Stack, MD.Eversion of the lid may reveal a dilated meibomian gland and chronic inspissation of adjoining glands. A gentle compression of these glands produces copious toothpastelike secretions instead of the normal small amount of clear oily secretions.The following should be kept in mind during the physical examination: Injection of the palpebral conjunctiva is a common secondary finding Preauricular nodes should be examined to help determine whether infection is present No intraocular pathology should be found The presence of fever or distant nodes is not consistent with a chalazionOther skin findings (eg, acne, seborrhea, rosacea, atopy) should be noted. Rosacea is a finding frequently associated with a chalazion. When present, rosacea demonstrates specific characteristics, such as facial erythema; telangiectatic and spider nevi on the malar, nasal, and lid skin; and rhinophyma.ComplicationsPotential complications of chalazia include cosmetic deformity and infection, including the development of hordeolum or preseptal cellulitis.Improperly drained marginal chalazia can result in notching, trichiasis, and loss of lashes. Partially drained chalazia can result in large masses of granulation tissue prolapsing through the conjunctiva or skin.Visual disturbances can occur with large chalazia, and astigmatism may arise when the lid mass distorts the corneal contour.Recurrences of chalazia are not uncommon. However, the physician should entertain the possibility of malignancy in such cases and should biopsy a lesion that recurs or appears atypical. The pathologist should be alerted to the suspicion of sebaceous cell carcinoma and frozen sections and lipid stains should be requested.Diagnostic ConsiderationsIn addition to the conditions listed in the differential diagnosis, other problems to be considered include the following: Hyperimmunoglobulinemia E (hyper-IgE) syndrome (Job syndrome) Meibomianitis Meibomian cell carcinoma Microcystic adnexal carcinoma Plexiform neurofibroma Staphylococcus aureusinfection Virus-induced infectionDifferential Diagnoses Acute Complications of Sarcoidosis Adult Blepharitis Adult Ptosis Allergic Contact Dermatitis Atopic Dermatitis in Emergency Medicine Bacterial Conjunctivitis Basal Cell Carcinoma Capillary Hemangioma Cavernous Hemangioma Congenital Anomalies of the Nasolacrimal Duct Conjunctival Melanoma Contact Lens Complications Dacryoadenitis Dacryocystitis Demodicosis Dermatochalasis Dermatologic Manifestations of Kaposi Sarcoma Distichiasis Eyelid Papilloma Floppy Eyelid Syndrome Herpes Simplex in Emergency Medicine Herpes Zoster Hordeolum Imaging in Sturge-Weber Syndrome Juvenile Xanthogranuloma Lacrimal Gland Tumors Leishmaniasis Molluscum Contagiosum Obstruction Nasolacrimal Duct Ocular Manifestations of HIV Infection Ophthalmologic Manifestations of Neurofibromatosis Type 1 Orbital Cellulitis Orbital Dermoid Orbital Tumors Pediatric Actinomycosis Pediatric Tuberculosis Pigmented Lesions of the Eyelid Preseptal Cellulitis Psoriasis Red Eye Evaluation Sebaceous Gland Carcinoma Squamous Cell Carcinoma, Conjunctival Squamous Cell Carcinoma, Eyelid Trichiasis Widow Spider Envenomation XanthelasmaApproach ConsiderationsThe diagnosis of chalazion is usually a clinical one and often does not require further workup. The healthcare provider should be certain that the eyelid lesion is a sterile inflammation that will resolve with limited intervention. Recurrent symptoms or persistent lesions should prompt further investigation.Recurrent chalazia, especially if they recur despite previous successful drainage in the same location, must be considered potentially malignant and biopsied. Some specialists recommend biopsy and drainage of all chalazia, whether primary or recurrent.Laboratory StudiesThe material obtained from a chalazion shows a mixture of acute and chronic inflammatory cells, as well as large, lipid-filled, foreign bodytype giant cells. Lipid analysis may reveal fatty acids with long carbon chains that result in an increased melting point. This finding possibly accounts for the blockage of secretions.Viral and bacterial cultures may help pinpoint an infectious etiology but tend to have a low yield. Although bacterial culture findings are usually negative,S aureus, Staphylococcus albus,or another cutaneous commensal organism may be isolated.Propionibacterium acnesmay be present in the glandular contents.Fine-needle aspiration cytology of atypical chalazia can confirm a diagnosis and exclude malignancy. It is best performed by an eye specialist.Other StudiesInfrared photographic imaging of the meibomian glands can demonstrate abnormally dilated glands through the everted lid, as well as inspissated secretions.Visual acuity testing and visual field testing should also be considered as appropriate.Histologic FindingsHistologic examination reveals a chronic granulomatous reaction with numerous lipid-filled, Touton-type giant cells. Typically, the nuclei of these cells are located around a central foamy cytoplasmic area that contains the ingested lipid material. Other typical mononuclear cells (eg, lymphocytes or macrophages) may also be found at the periphery of the lesion.In the event of a secondary bacterial infection, an acute necrotic reaction with PMNs may ensue.Destruction of the fibrocartilage of the tarsal plate may be evident.Foreign bodies (eg, embedded parts of polymethyl methacrylate [PMMA] contact lenses) in the tarsal plate have also been encountered in cases of chronic chalazia.Approach ConsiderationsAlthough a chalazion is not an emergency medical condition, it may be the reason for a patients presentation to the emergency department (ED). Conservative management (see Conservative Measures) should be initiated by the emergency or family physician; if the chalazion does not resolve within one month, the patient should be referred to an ophthalmologist for definitive examination and treatment.Small, inconspicuous, asymptomatic chalazia may be ignored. Otherwise, conservative treatment with lid massage, moist heat, and topical mild steroid drops should suffice.[12]Intralesional steroid injection may also be used. Antibiotics are usually unnecessary but should be considered in cases of possible infection. In select cases, incision and drainage may be beneficial. Urgent transfer to an orbital or ophthalmic plastic surgeon is mandatory if a sebaceous cell carcinoma is documented by biopsy results or suggested by clinical findings.Occasionally, patients present with profound concern about the causal factors for lid inflammation, including chalazion. They may have major anxiety because of misinformation that severeDemodex folliculoruminfestation may have triggered their lid disease. However, there is no evidence thatDemodexcauses lid disease; it appears to be a harmless commensal organism, though it has been implicated in mange in dogs. Treatment of demodicosis includes nocturnal application of ointment to the eyes, which smothers the parasite.Conservative MeasuresConservative management of chalazia includes warm compresses and lid hygiene.[8, 9]More than 50% of chalazia resolve with conservative treatment.Warm compresses (eg, a wet facecloth, as hot as can be tolerated) can be used to melt the lipid secretions, thereby encouraging resolution of the ductal blockage and facilitating the drainage of sebum. Compresses should be applied on the eyelids for 15 minutes 2-4 times per day.Baby shampoo or commercial lid wipes can be used over the eyelashes to remove debris blocking the ducts opening. Shampoo to treat seborrhea can also be used over the eyebrows to minimize possible ductal blockage from skin particles.A self-administered technique that can be beneficial is the 4 fingers times 10 massage, which is performed as follows: At the conclusion of a bath or shower, the patient warms his or her hands under hot water Using 1 drop of baby shampoo, which does not sting the eyes, the patient works up a lather The patient closes both eyes and covers the lashes and both the upper and lower eyelids with the index finger With the index finger placed over the closed lids at the lid margin, the patient vigorously massages the lid back and forth 10 times The patient then repeats the procedure with the middle, ring, and little fingers Finally, the patient rinses off the remaining shampooIn the office, and early in the course of a chalazion, a blocked glandular orifice may be opened, and the content of the chalazion expressed by means of vigorous massage between two cotton wool buds, preferably at the slit lamp; local anesthesia may be beneficial to facilitate a thorough massage. This technique works best for marginal chalazia and if they are not connected to another chalazion located deeper in the substance of the lid. If the contents cannot be expressed, the distal chalazion should be incised and the contents curetted (see Surgical Intervention).Pharmacologic TherapyFor the most part, topical or systemic antibiotics are not necessary, because chalazia are secondary to sterile inflammation. If an infectious process is present, acute therapy with a tetracycline (eg, doxycycline 100 mg/day or minocycline 50 mg/day PO for 10 days) minimizes the infectious component and decreases the inflammation, reputedly by inhibiting polymorph degranulation. Long-term low-dose tetracycline therapy (eg, doxycycline 100 mg/week PO for 6 months) frequently prevents recurrence.When tetracycline cannot be used (eg, because of patient allergy), metronidazole may be employed in a similar fashion. In most cases, surgery should be performed only after a few weeks of medical therapy.Topical steroids may be necessary to prevent the chronic inflammatory response, as well as the acute noninfectious reaction produced by irritants (eg, free fatty acids liberated by bacterial enzymes), from causing excessive scarring. Once the acute inflammation has subsided, revision and definitive curettage or excision of the granulomatous mass may be required.If no evidence of infection is present, local intralesional injection of a steroid (eg, triamcinolone or methylprednisolone) can reduce inflammation and may cause regression of the chalazion within a few weeks. Typically, 0.2-2 mL of 5 mg/mL triamcinolone is injected directly into the chalazions center. A second injection 2-7 days later may be necessary for larger chalazia.[13]A study by Ben Simon et al compared triamcinolone acetonide injections with incisions and curettage in 94 patients with chalazion.[14]The study determined that intralesional triamcinolone acetonide injection was as effective as incision and curettage and that it may be considered as an alternative first-line treatment when the diagnosis is straightforward, when biopsy is not required, or when the lesion is located near the lacrimal drainage system (eg, an incision could cause complications involving tear flow).Although steroid injections appear to be safe and effective in the treatment of primary chalazia,[15]potential complications include hypopigmentation, atrophy of the area, corneal perforation and traumatic cataract, elevated intraocular pressure, a visible depot of medication, and potential exacerbation of bacterial or viral infections. To minimize the risk of such complications, soluble aqueous preparations are preferred to crystalline suspensions. A transconjunctival injection route may provide a further safeguard.Use of steroids and surgical drainage (see below) should be reserved for an ophthalmologist or a plastic surgeon.[10]Injection and removal of chalazia may create cosmetic morbidity.[11]Surgical InterventionProper surgical management is best performed by an ophthalmologist or another practitioner who is thoroughly familiar with eyelid anatomy and necessary surgical techniques.Anesthesia is established by means of a local infiltration, possibly augmented with topical anesthetic cream (eutectic mixture of local anesthetics [EMLAs]) to reduce the pain of the injection in young patients.A chalazion clamp is applied to evert the lid and to control bleeding. A transconjunctival vertical incision, to avoid damaging nearby glands, is made in the lesion with a sharp blade, going no closer than 2-3 mm to the lid margin. Care must be taken to keep from perforating the skin and when incising near the lacrimal drainage system to prevent serious complications involving tear flow. For small chalazia, curettage of the inflammatory granuloma in the lid, including any cyst lining, is performed. Curettage should not be overly aggressive, as it can disseminate the inflammation by breaking down tissue barriers. For larger chalazia, dissection of the granuloma may be needed for complete removal. The meibomian gland may be cauterized with phenol or trichloroacetic acid or even removed to prevent recurrences.After removing the chalazion clamp, a topical antibiotic ointment covering the normal skin flora (eg, erythromycin) can be applied to the incision site to prevent infection. A few minutes of pressure usually suffices to establish hemostasis. Finally, a light pressure bandage should be applied for a few hours to absorb any further oozing.If a chalazion threatens to break through the skin or has drained through, an external approach may be recommended. A horizontal incision is made in the skin at least 3 mm from the lid margin in an existing crease, with care taken not to sacrifice normal tissue. Curettage and dissection are then performed as above. After hemostasis is achieved, the wound may be closed with appropriate sutures (eg, 7-0 silk).Note that involvement of both skin and conjunctiva may necessitate offsetting the incisions to avoid fistula formation.Large or chronically neglected and excessively fibrotic chalazia may require more extensive surgical excision, including removal of parts of the tarsal plate. Leaving a 3-mm bridge of normal tarsus near the lid margin prevents notching. Multiple chalazia may be excised carefully, without fear of major lid deformity; the fibrous tarsal plate heals without leaving gaps. Even complete tarsal plate removal has been reported not to cause a lid deformity.Poorly executed incisions (eg, those transgressing the edge of the lid) may result in notching. Incisions that are too deep may cause cutaneous fistulae and scars. Inadequate curettage and drainage may lead to recurrences or the development of granulomata.Finally, it is imperative to biopsy a recurrent chalazion to rule out a sebaceous cell carcinoma. If a biopsy is indicated, it may be performed by simply excising a section of the remaining edge of the lesion. It is important not to have the specimen processed as usual but, instead, to make a specific request to the pathologist to rule out sebaceous cell carcinoma and, in particular, to consider using fat stains.Diet and ActivityDietary modification has not been evaluated in the management of chalazion. In certain individuals, the advice given to patients with severe acnenamely, to avoid or decrease their ingestion of coffee, chocolate and highly refined foods, as well as fried foods and those containing saturated fatsmay be appropriate.Sufficient sleep, moderate sun exposure, exercise, and fresh air may be of benefit to cutaneous health and hygiene of the skin and glands of the eyelids. Stress is often associated with episodes of recurrent chalazia, although a causal role has not been established.PreventionProphylaxis involves daily eyelid hygiene and massages. Heat and moisture are also critical to empty the glands.The 4 fingers times 10 routine (see Conservative Measures) is often useful. An alternate method that is both effective and easy to perform is to apply warm moist compresses on the lids. The middle section of a clean facecloth is shaped so as to look like a finger and then placed under running warm water. It is then used to gently massage the upper and lower eyelids in a horizontal motion to open up any blocked glands.Using antidandruff shampoo on the eyebrows can also lessen the occurrence of skin particles causing blockages, especially in those who are prone to seborrhea.The use of topical mild steroid or antibiotic drops may also help suppress the granulomatous inflammation.Finally, note that typical chalazia do occur more frequently in patients with immune disorders or acne rosacea and in individuals who have high exposure to ultraviolet (UV) radiation. Theoretically, therefore, chalazion formation could be reduced by managing these medical conditions and by limiting UV exposure through the use of sunglasses and hats.ConsultationsIf a chalazion does not resolve with conservative management, referral to an ophthalmologist for follow-up care after 1 month is appropriate. For recurrent chalazia that have not been further evaluated, earlier referral is warranted.Referral to a dermatologist may also be beneficial in helping to treat problems with rosacea or sebaceous dysfunction, as skin disorders can predispose to chalazia.Long-Term MonitoringRoutine follow-up after 1 month should reveal resolution of the chalazion, with no swelling, redness or persistent lump. If the chalazion does not resolve, if a recurrence develops, or if additional symptoms arise, follow-up care with an ophthalmologist is advised. Any persistence of a nodule should lead the healthcare provider to review the diagnosis and entertain the possibility of a sebaceous cell carcinoma or another lid lesion.For further evaluation and management, appropriate tissue specimens should be obtained for histologic study. Because sebaceous cell carcinoma is best evaluated using lipid stains, the pathologist should be alerted to perform tissue processing without dehydration (ie, frozen section). The specimen should still be prepared in formalin to avoid autolysis; formalin does not remove lipids, whereas alcohol baths used in paraffin sectioning do.Medication SummaryMedical therapy for a chalazion is only rarely indicated, except in cases of rosacea, for which a 6-month course of low-dose tetracycline may be of benefit. Doxycycline in dosages as low as 100 mg/week for 6 months may result in permanent biochemical change, with the sebaceous glands producing shorter-chain fatty acids, which are less likely to congeal and block gland orifices than longer-chain fatty acids are.Although probably innocuous, topical antibiotics do not help this condition, which is not infectious. Systemic tetracycline may be beneficial, but local drops are unlikely to help and are more likely to cause a contact dermatitis-type reaction. Long-term oral tetracycline, doxycycline, or metronidazole may be useful in the setting of chronic, recurrent chalazia.Topical steroids can be helpful in minimizing inflammation and in reducing edema, thereby facilitating any drainage that may take place.AntibioticsClass SummaryAntibiotics are not indicated as treatment of infection. Significant benefit may be derived from low-dose, long-term therapy with tetracycline.View full drug informationTetracyclineThe useful effects of tetracycline in patients with chalazion include altering the skin bacterial flora and altering lipids to produce shorter-chain fatty acids (thereby lowering the melting point of sebaceous secretions and possibly preventing blockage of meibomian glands).View full drug informationDoxycycline (Doryx, Vibramycin, Adoxa, Doxy 100)Doxycycline inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. It alters lipids to produce shorter-chain fatty acids (thereby lowering the melting point of sebaceous secretions and possibly preventing blockage of meibomian glands).View full drug informationMinocycline (Minocin, Solodyn)Minocycline alters lipids to produce shorter-chain fatty acids (thereby lowering the melting point of sebaceous secretions and possibly preventing blockage of Meibomian glands).View full drug informationMetronidazole (Flagyl, Metro)When taken orally, metronidazole may benefit patients who are unable to take tetracyclines.CorticosteroidsClass SummaryCorticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the immune response of the body to diverse stimuli.Triamcinolone acetonide (Kenalog, Aristospan Intralesional)The advantages of triamcinolone over other depot corticosteroids are decreased discomfort and reduced cost. Triamcinolone is used for inflammatory dermatosis responsive to steroids. This agent decreases inflammation by suppressing migration of PMNs and reversing capillary permeability. It acts to minimize scarring and inflammation.

DAPUS :1. Chalazion, Jean Deschnes, Jane Lee Fansler,Alexandre Plouznikoff, Oct 31, 2014 http://emedicine.medscape.com/article/1212709-overview2. Wong MY, Yau GS, Lee JW, Yuen CY. Intralesional triamcinolone acetonide injection for the treatment of primary chalazions.Int Ophthalmol. 2014 Oct. 34(5):1049-53.3. Gilchrist H, Lee G. Management of chalazia in general practice.Aust Fam Physician. 2009 May. 38(5):311-4.4. Sharma R, Brunette DD. Ophthalmology. In: Marx, ed. Rosens Emergency Medicine. Vol 2. 7th ed. 2009:Chap 69.5.