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Chalizioma

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A chalazion is a chronic, sterile granulomatous inflammation of a meibomian (tarsal) gland in the eyelid, caused by retained secretions blocking the gland duct. It typically presents as a painless, firm nodule on the upper or lower eyelid.
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Chalazion (Meibomian Cyst)

Definition

A chalazion is a sterile, chronic granulomatous inflammatory lesion (lipogranuloma) of the meibomian gland (or occasionally the gland of Zeis) in the eyelid, caused by obstruction of the gland duct with retained lipid-rich sebaceous secretions. The retained material acts as a foreign body, triggering a granulomatous foreign-body inflammatory reaction.
  • Goldman-Cecil Medicine, p. 302
  • Kanski's Clinical Ophthalmology 10th ed., p. 54

Pathogenesis & Histology

The blocked meibomian gland secretion forms a collection that stimulates:
  • Lipogranulomatous inflammation - extracellular fat deposits
  • Surrounded by lipid-laden epithelioid cells and multinucleated giant cells
  • Background infiltrate of lymphocytes
Histopathology (Fig. A below): lipogranuloma with large pale epithelioid cells and well-demarcated empty spaces (fat dissolved out during processing)
Histopathology of chalazion showing lipogranuloma with empty fat spaces and surrounding epithelioid cells
Clinical appearance (Fig. B): painless, firm nodule in the upper or lower eyelid
Clinical photo of uninflamed chalazion presenting as a raised, reddish nodule on the upper eyelid

Associated Conditions

ConditionRelevance
BlepharitisCommonly co-present
Acne rosaceaAssociated with multiple/recurrent chalazia
Bortezomib (proteasome inhibitor for myeloma)Predisposes to chalazia within 3 months of initiation
Sebaceous carcinomaMust be excluded in recurrent lesions, especially in older patients

Symptoms & Signs

Symptoms: Acute or chronic eyelid lump, swelling, tenderness (can be painless or painful)
Critical sign: Visible or palpable, well-defined, subcutaneous nodule in the eyelid
Other signs:
  • Blocked meibomian gland orifice
  • Eyelid swelling and erythema
  • Focal tenderness
  • Associated blepharitis or acne rosacea
  • Lesion may drain mucopurulent material

Chalazion vs. Hordeolum

FeatureChalazionHordeolum (Stye)
NatureSterile, chronic granulomatousAcute bacterial abscess
Gland involvedMeibomian (± Zeis)Meibomian (internal) / Zeis or Moll (external)
PainPainless or mildly tenderPainful
OrganismNone (sterile)Usually Staphylococcus spp.
NoduleWell-defined, firm, non-mobileTender, may point at lid margin

Differential Diagnosis

  • Preseptal cellulitis - periorbital erythema, edema, warmth
  • Sebaceous carcinoma - recurrent chalazia, eyelid thickening, madarosis, chronic unilateral blepharitis in older patients
  • Pyogenic granuloma - benign, red, pedunculated conjunctival lesion
  • Forniceal foreign body - especially in contact lens wearers
Key clinical tip: If a chalazion recurs at the same lid position in an older patient, biopsy is mandatory to exclude malignancy (sebaceous carcinoma). - Kanski's Clinical Ophthalmology

Workup

  1. History: Previous ocular surgery/trauma? Previous chalazia?
  2. External examination: Palpate eyelid for nodule; look for rosacea
  3. Slit lamp: Evaluate meibomian glands for inspissation, evert eyelid; assess for madarosis, poliosis, ulceration

Treatment

Step 1 - Conservative (all cases)

  • Warm compresses for at least 10 minutes 4x daily with gentle massage over the lesion
  • Most lesions resolve over days to weeks

Step 2 - Medical (if needed)

  • Topical antibiotic/steroid (e.g., neomycin/polymyxin B/dexamethasone ointment b.i.d. for 1-2 weeks)
  • Chronic low-dose doxycycline 20-50 mg p.o. daily to b.i.d. for multiple/recurrent chalazia or ocular rosacea (antibacterial + anti-inflammatory)

Step 3 - Procedural (failure after 3-4 weeks)

Option A: Incision and curettage (I&C)
  • Chalazion clamp applied with open side inside the eyelid
  • Vertical incision through conjunctival surface
  • Curettage of contents
Option B: Intralesional steroid injection
  • Triamcinolone 40 mg/mL mixed 1:1 with 2% lidocaine with epinephrine (0.2-1.0 mL total, depending on lesion size)
  • Alternatives: betamethasone combinations or dexamethasone sodium phosphate 4 mg/mL
Warning on steroid injection: Can cause permanent depigmentation or skin atrophy at the injection site - especially in dark-skinned individuals. Rarely, vigorous injection can cause retrograde intra-arterial infiltration with central retinal artery occlusion. Use with detailed patient counselling.

All removed specimens - send to pathology

Especially recurrent or atypical chalazia.

Follow-Up

  • Medical therapy: reassess only if lesion persists beyond 3-4 weeks
  • After I&C: reexamine as needed
  • The Wills Eye Manual, pp. 381-383
  • Kanski's Clinical Ophthalmology 10th ed., p. 54
  • Goldman-Cecil Medicine, p. 302
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