Chalazion (Lump in Eyelid)

What Is a Chalazion?

The definition of a chalazion is a lump in the upper or lower eyelid that is caused by obstruction of the drainage duct of an oil gland within the eyelid. This lump may increase in size over days to weeks and may occasionally become red, warm, or painful. The gland involved in the formation of a chalazion is an oil gland unique to the eyelids called a meibomian gland. These glands secrete oil onto the surface of the eyes with each blink to keep the corneas well lubricated. The opening of the glands are located at the rim or edge of the eyelids. When one of these glands becomes blocked, it can increase in size and cause a visible lump.

  • A chalazion is not contagious.
  • It can develop at any age, including childhood.

It is usually painless, although the area may be somewhat tender to touch. It is fairly common and will often disappear on its own or with treatment with warm compresses.

What Causes a Chalazion?

Each of the meibomian oil glands produces oil that flows out of the gland onto the eye's surface. There are about 40-50 meibomian glands within the upper lid and about 25 within the lower lid. They are actually located within the tarsal plate, which is a firm tissue located under the skin of the lids. The oil exits from each gland through a tiny circular opening just behind the eyelashes of the upper and lower lids of both eyes. A chalazion is caused by the oil in the gland becoming too thick to flow out of the gland or the opening of the gland being obstructed. Without anywhere to go, the oil builds up inside of the eyelid gland and forms a type of meibomian cyst. The trapped oily material can have the texture of solid butter or even hardened wax. The gland wall may leak, releasing the oil into the tissue of the eyelid, causing inflammation and sometimes scar tissue. Alternative names for a chalazion include conjunctival granuloma, internal hordeolum, conjunctival lipogranuloma, or meibomian gland lipogranuloma.

Chalazion vs. Stye (Sty)

A stye is also a lump or cyst in the eyelid caused by obstruction of an eyelid gland. A stye, or hordeolum, is a plugged oil or sweat gland in the skin of the eyelid and usually resolves much more quickly than a chalazion. Like a chalazion, a stye may start out as an inflammation but can become infected as well.

What Are Chalazion Risk Factors?

Risk factors for a chalazion include

What Are Chalazion Symptoms and Signs?

  • Swelling of the gland may appear abruptly but more commonly develops gradually over weeks.
  • They occur more frequently on the upper lid, probably because there are more meibomian glands in the upper eyelid than in the lower eyelid.
  • A chalazion feels firm or hard to the touch and may enlarge to the size of a green pea. Occasionally, a chalazion is painful, particularly if it's very inflamed or infected.
  • The pain frequently is more pronounced when the chalazion first forms.
  • Drainage from the gland may cause irritation of the conjunctival and corneal surface of the eye.
  • The overlying or surrounding eyelid skin may be red. The palpebral conjunctiva (the tissue lining the back side of the eyelid) may also be swollen and red.

When Should Someone See a Doctor for Treatment of a Chalazion?

Call a primary care doctor or an ophthalmologist (a medical doctor who specializes in the diagnosis and medical and surgical treatment of eye disease) for an appointment if eyelid redness or swelling does not improve with warm compresses. Medicine will be needed if there are signs of infection.

Contact an eye doctor immediately if experiencing any of the following signs of serious infection:

  • Fever and/or body aches
  • Headache
  • Double vision or worsening vision
  • Protrusion of the eye
  • Blurred vision
  • Eye pain
  • Eye redness with or without drainage
  • Extensive swelling or redness of the eyelid, especially if it is spreading beyond the borders of the chalazion
  • A child may need to be treated more urgently if a large chalazion is pressing against the eye and causing blurred vision from astigmatism. In young children, unrecognized blurred vision can lead to strabismus or amblyopia (reduced vision due to abnormal development).

In very rare cases, a longstanding chalazion may show additional signs (such as irregular skin, loss of lashes, abnormal blood vessels) that could indicate a form of cancer in the eyelid. Be sure to notify your doctor if you have these uncommon but serious signs.

Causes of Eye Pain

Styes and Chalazia

A sty or a chalazion causes eye pain because of local irritation. Either of these conditions cause a lump you can see or feel within the eyelid. The lump is a result of a blocked oil gland within the eyelid. This lump causes irritation to the eye, can be very painful to the touch, and can occur in both children and adults.

How Do Health Care Professionals Diagnose a Chalazion?

A health care provider will take a detailed patient health history and perform a physical examination. The medical examination includes vision testing of each eye and an inspection of the face, eyelids, and the eye itself. If you have frequent chalazion infections, your health care provider might perform a more thorough examination and order blood tests (to check for chronic illnesses such as diabetes).

Are There Chalazion Home Remedies?

  • Applying a warm compress to the affected area of the eyelid is the best treatment. Hold a warm compress on the eyelid for 15 minutes, four times a day. This will promote drainage of the gland.
  • The warm compress can be a towel soaked in warm water (though it will have to be rewarmed frequently), a microwavable eye pad (sold in most pharmacies), or an electric heating pad or blanket. It should be warm but not hot. Chemicals like apple cider vinegar and Epsom salts are not recommended as they may further irritate the delicate eyelid skin.
  • Lightly massaging the affected area after the warm compress treatment may also help.
  • Do not pop, poke, stab, puncture, pinch, or scratch the chalazion. Doing so could create scar tissue and make the gland prone to re-clogging.
  • Be patient. A chalazion can take weeks or even months to completely resolve.
  • If your eye doctor finds that you have either meibomian gland disease or blepharitis, you'll get medical advice on how best to treat so you can reduce the odds of forming another chalazion in the future.
  • Be sure to seek medical attention right away for the signs of serious infection mentioned above.

What Is Are Chalazion Treatment Options? Does Surgery Treat Chalazia?

The initial treatment is warm compresses and treatment of any chronic inflammation from meibomian gland dysfunction or blepharitis. You'll be instructed to apply warm compresses as mentioned above (see Home Remedies). This is the safest way to treat the chalazion without forming scar tissue, which could make the gland vulnerable to future clogging.

A health care provider will prescribe antibiotic eyedrops or ointments if a bacterial eye infection is present. If there is no improvement after several days or weeks of warm compresses, more aggressive treatment may be offered.

Injection of a steroid into the chalazion may help decrease the inflammation and speed its resolution. You'll still need to continue frequent warm compresses following the steroid injection. There are some risks with steroid injection, such as bruising or permanent discoloration of the skin overlying the injection site. The chalazion can also be debulked surgically by incision and drainage. This is usually reserved as a last resort. The ophthalmologist will inject a numbing medication and secure a small clamp on the lid. The eyelid is then everted, and an incision in made on the back side of the lid. The oily contents of the gland are then removed with a curette instrument. Surgery recovery is usually quick but warm compresses should be continued for a few more days to soften any residual trapped oil.

Patients who develop multiple chalazia or recurrent chalazia may have an underlying abnormality in the oil glands, such as meibomian gland dysfunction (MGD) or blepharitis. Your eye doctor can make that diagnosis with a slit lamp examination. . MGD is often associated with acne rosacea of the face. Treatment involves daily warm compresses, baby shampoo lid scrubs, and possible use of long-term low-dose oral antibiotics in the tetracycline family like doxycycline or minocycline to alter the consistency of the oils produced by the glands. Children and women who are pregnant or breastfeeding cannot safely use oral tetracyclines.

If your doctor finds signs of preseptal cellulitis (infection spreading from the chalazion to the surrounding skin), an oral antibiotic will be prescribed. If the infection spreads posteriorly into the orbit, urgent treatment with intravenous antibiotics and possible hospitalization will be necessary.

What Is the Prognosis of a Chalazion?

Typically, a chalazion heals within a few weeks, but in some cases, it resolves slowly over months. If no infection or scarring develop, there are no long-term health consequences and it is unlikely to recur. However, in patients with untreated meibomian gland dysfunction or chronic blepharitis, another chalazion may develop later in any of the eyelids.

Is It Possible to Prevent a Chalazion?

Preventive measures against the development of a chalazion include ensuring that the lid margins are clean and that oil gland flow remains unobstructed. Treatment of underlying MGD and blepharitis are the best defenses against recurrence.

For More Information about Chalazia

American Academy of Ophthalmology (AAO.org)
655 Beach Street
Box 7424
San Francisco, CA 94120
415-561-8500

Chalazion Pictures

Chalazion. Photo courtesy of Larry Stack, MD.
Chalazion. Photo courtesy of Larry Stack, MD.

Chalazion with an inverted eyelid. Photo courtesy of Larry Stack, MD.
Chalazion with an inverted eyelid. Photo courtesy of Larry Stack, MD.

Picture of a chalazion. Photo courtesy of Andrew A. Dahl, MD, FACS.
Picture of a chalazion. Photo courtesy of Andrew A. Dahl, MD, FACS.

Reviewed on 9/11/2017

REFERENCES:

Aycinena, A.R., A. Achiron, M. Paul, and Z. Burgansky-Eliash. "Incision and Curettage Versus Steroid Injection for the Treatment of Chalazia: A Meta-Analysis." Ophthal Plast Reconstr Surg 32.3 May-June 2016: 220-4.

Driver, Paul J., and Lemp, Michael A. "Meibomian Gland Dysfunction." Survey of Ophthalmology 40.5 Mar. 1996: 343-367.

Neff, A.G., and K.D. Carter. "Benign Eyelid Lesions." Ophthalmology, 3rd ed. St. Louis, MO: Mosby Elsevier, 2008.

Papier, A., D.J. Tuttle, and T.J. Mahar. "Differential Diagnosis of the Swollen Red Eyelid." Am Fam Physician 76 (2007): 1815-1824.

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