Chalazion

A chalazion is a chronic inflammatory granuloma of a meibomian gland. It appears to be caused by alterations in secretions with retention of secretory material due to obstruction of the ducts. Chalazia originating in the Zeis sebaceous glands are termed “external chalazia”; those in the meibomian glands of the tarsus are termed “internal chalazia.”

Associated Conditions

Conditions associated with chalazia include:

• Seborrhea: red, itchy rashes and white scales. When on the scalp, this is dandruff but can occur on parts of the face as well, including the folds around the nose and behind the ears, the forehead, and the eyebrows and eyelids.
• Chronic blepharitis: inflammatory condition resulting from too much bacteria on your eyelids at the base of your eyelashes, or if the oil glands in your eyelids get clogged or irritated.
• Acne rosacea: a long-term disease that causes redness and pimples, most common in women and in people with fair skin (also mostly older adults).

Presentation

A chalazion often starts as a soft tissue swelling on the eyelid that can be present for for weeks or months. Patients usually seek medical attention when the condition worsens (impaired vision, discomfort, further inflammation/infection). It is common to see erythema, or superficial reddening of the skin, usually in patches, as a result of injury or irritation causing dilatation of the blood capillaries. Also chalazia present as firm nodules or small firm lumps. If the nodules are filled with fluid they are usually softer and referred to as cysts.

Course

As the gland fills with oily secretions, it increases in size over weeks. The lesion most commonly is seen to bulge externally through the skin and less commonly through the conjunctiva. It might possibly remain contained within the tarsus or break through anteriorly beneath the skin or on the conjunctival side, inducing pyogenic granuloma formation.

Treatment

Medical treatment consists of warm compresses and topical antibiotic ointment.
When the chalazion does not respond to more conservative medical management after 2 weeks, or when the lesion is large and symptomatic, surgical excision is indicated. Once excised, patients need to continue treatment with warm compresses and/or an antibiotic-steroid ointment.

Warnings

It should be emphasized that any atypical or recurrent chalazion must be regarded as a possible neoplastic lesion and should be biopsied. Basal cell carcinoma squamous cell carcinoma, and adenocarcinoma of the meibomian glands all have been mistaken for chalazia; these are malignant. Malignancy is the tendency of a cancer or tumor either to invade the surrounding tissues, to destroy or replace the tissues previously present, or to metastasize (spread to other parts of the body) tumors.