Chalazion

For other uses, see Chalazion (fungus).

Chalazion
Classification and external resources
Eyelid affected by Chalazion
ICD-10	H00.1
ICD-9	373.2
DiseasesDB	6009
MedlinePlus	001006
eMedicine	emerg/94 oph/243
MeSH	D017043

A chalazion ( /kəˈleɪziən/; plural chalazia /kəˈleɪziə/), also known as a meibomian gland lipogranuloma, is a cyst in the eyelid that is caused by inflammation of a blocked meibomian gland, usually on the upper eyelid. Chalazia differ from styes (hordeola) in that they are subacute and usually painless nodules. They may become acutely inflamed but, unlike a stye, chalazia usually point inside the lid rather than on the lid margin.

Signs and symptoms

• Swelling on the eyelid
• Eyelid tenderness
• Sensitivity to light
• Increased tearing
• Heaviness of the eyelid

A chalazion or meibomian cyst can sometimes be mistaken for a stye.

Treatment

A large chalazion ca. 20 minutes upon excision. This bipartite chalazion was removed via two separate incisions. Further along the lower eyelid, signs of chronic inflammation (Blepharitis) are visible.

Topical antibiotic eye drops or ointment (e.g. chloramphenicol or fusidic acid) are sometimes used for the initial acute infection, but are otherwise of little value in treating a chalazion. Chalazia will often disappear without further treatment within a few months and virtually all will resorb within two years.^[1]

If they continue to enlarge or fail to settle within a few months, then smaller lesions may be injected with a corticosteroid or larger ones may be surgically removed using local anesthesia.^[2][3] This is usually done from underneath the eyelid to avoid a scar on the skin. If the chalazion is located directly under the eyelid's outer tissue, however, an excision from above may be more advisable so as not to inflict any unnecessary damage on the lid itself. Eyelid epidermis usually mends well, without leaving any visible scar.^[4] Depending on the chalazion's texture, the excision procedure varies: while fluid matter can easily be removed under minimal invasivion, by merely puncturing the chalazion and exerting pressure upon the surrounding tissue, hardened matter usually necessitates a larger incision, through which it can be scraped out. Any residual matter should be metabolized in the course of the subsequent healing process, generally aided by regular appliance of dry heat. The excision of larger chalazia may result in visible hematoma around the lid, which will wear off within three or four days, whereas the swelling may persist for longer. Chalazion excision is an ambulant treatment and normally does not take longer than fifteen minutes. Nevertheless, owing to the risks of infection and severe damage to the eyelid, such procedures should only be performed by a medical professional.

It is rare that a chalazion will recur and they will usually be biopsied to rule out the possibility of a tumour.

Complications

A large chalazion can cause astigmatism due to pressure on the cornea.

As laser eye surgery involves shaping the cornea by burning parts of it away, weakening its structure, post operation patients can be left predisposed to deformation of the cornea from small chalazia.

Complications including, but not limited to hypopigmentation may occur with corticosteroid injection.

Recurring chalazia in the same area may sometimes be a symptom of sebaceous cell carcinoma, albeit rarely. This is a type of cancer.

Sometimes, as a last resort, surgery is performed. The eyelid is injected with a local anesthetic, a clamp is put on the eyelid, then the eyelid is turned over, an incision is made on the inside of the eyelid, and the chalazion is drained and scraped out. A scar on the upper lid can cause discomfort as some patients feel the scar as they blink. Of course as surgeries are intrusive and damage healthy tissue (e.g. leaving behind scar tissue or possibly even causing blepharitis), given other options, less intrusive treatment is always preferable. Similarly, chalazia may recur once the eye is predisposed and surgical intervention each time is not possible. So surgery should be considered only as a last resort, performed on as few as 5% of all chalazia patients.

Chalazion surgery

Chalazion surgery is normally performed by an ophthalmologist at an eye hospital.^[5] This type of surgery is a simple procedure which is generally performed as a day operation and the patient does not need to remain in the hospital for further medical care.^[6]

Chalazion removal surgery is performed under local or general anesthesia. Commonly, general anesthesia is administered in children to make sure they stay still and no injury to the eye occurs. Local anesthesia is used in adults and it is applied with a small injection into the eyelid. The discomfort of the injection is minimized with the help of an anesthetic cream which is applied locally.

Classic lipogranulomatous response seen in a well-developed chalazion.

The chalazion may be removed in two ways, depending on the size of cyst. Relatively small chalazia are removed through a small cut at the back of the eyelid.^[7] The surgeon lifts the eyelid so he can have access to the back of its surface and makes an incision of approximately 3mm just on top of the chalazion. The lump is then removed and pressure is applied for a few minutes to stop any oozing of blood that may occur because of the operation.^[8] Surgery of small chalazia does not require stitches as the cut is at the back of the eyelid and therefore the cut cannot be seen and the cosmetic result is excellent.

Larger chalazia are removed through an incision in front of the eyelid. Larger chalazia usually push on the skin of the eyelid and this is the main reason why doctors prefer removing them this way. The cut is not larger than 3 mm and it is performed on top of the chalazion. The lump is removed and then pressure is applied on the incision so oozing is prevented. This type of surgery is closed with very fine stitches. They are hardly visible and they are usually removed within a week after the surgery has been performed. Although chalazia are rarely dangerous, every removed chalazion is sent to the laboratory to be examined^{[citation needed]} under a microscope because very rarely it can harbor cancer.

When surgery for chalazion is considered, patients who take aspirin or any medication that contains aspirin are advised to stop taking them one week before the procedure as they may cause bleeding. There are several tests taken prior the surgery to make sure the patient is in good condition for the operation.

In rare cases, patients are kept overnight in the hospital after chalazion surgery. These include cases in which complications occurred and the patient needs to be closely monitored. In most cases however, patients are able to go home after the operation has ended.

The recovery process is easy and quite fast. Most patients experience some very minor discomfort in the eye which can be easily controlled by taking painkilling medication. Patients are however recommended to avoid getting water in the eye for up to 10 days after surgery, they may wash, bathe or shower but they must be careful in keeping the area dry and clean. Makeup may be worn after one month after surgery. Patients are recommended to not wear contact lenses on in the operated side for at least eight weeks to prevent infection and potential complications.

Commonly, patients receive eye drops to prevent infection and swellings in the eye and pain medication that will help them cope with the pain and discomfort in the eyelid and eye. One can use paracetamol/tylenol rather than aspirin to control the pain. Also, after surgery, a pad and protective plastic shield are used to apply pressure on the eye in order to prevent leakage of blood after the operation and which may be removed 6 to 8 hours after the procedure.

People who undergo chalazion surgery are normally asked to check up their operation three to four weeks after surgery has been performed. They may start driving the day after surgery and they may get back to work in one or two days.

Chalazion surgery is a safe procedure and complications occur very seldom. Serious complications that require another operation to be fixed are also very rare. Among potential complications, although rare, there is infection, bleeding or the recurrence of the chalazion.

See also

• Blepharitis
• Stye

References

1. ^ Chalazion 2080768019 at GPnotebook
2. ^ Khurana A, Ahluwalia B, Rajan C (1988). "Chalazion therapy. Intralesional steroids versus incision and curettage". Acta Ophthalmol (Copenh) 66 (3): 352–4. doi:10.1111/j.1755-3768.1988.tb04609.x. PMID 10994460. 
3. ^ Jackson T, Beun L (2000). "A prospective study of cost, patient satisfaction, and outcome of treatment of chalazion by medical and nursing staff". Br J Ophthalmol 84 (7): 782–5. doi:10.1136/bjo.84.7.782. PMC 1723539. PMID 10873994. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1723539.  — in which of those cases attending a District General Hospital, approximately one third of selected chalazia resolved within 3 months with conservative treatment, and surgical treatment was successful for 72%.
4. ^ Gerstenkorn/Hagelkorn
5. ^ "Chalazion: Chalazion Treatment, Chalazion Removal, What Cause Chalazion, Chalazion Eye". http://www.total-health-care.com/illness/chalazion.htm. Retrieved 2010-04-12. 
6. ^ "Chalazion Surgery Factual Information". http://www.chalazionsurgery.com/. Retrieved 2010-04-12. 
7. ^ "Removal of chalazion". http://www.netdoctor.co.uk/surgical-procedures/removal-of-chalazion.htm. Retrieved 2010-04-12. 
8. ^ "The operation". http://www.netdoctor.co.uk/surgical-procedures/removal-of-chalazion.htm. Retrieved 2010-04-12. 

External links

• William Charles Caccamise Sr. "A cache of photographs of various stages of the chalazion". EyeRounds.org. http://webeye.ophth.uiowa.edu/eyeforum/atlassearch1.htm?appSession=53915620846591.