Chalazion: Difference between revisions
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==Background== | ==Background== | ||
[[File:Gray896.png|thumb|Anterior view of the right eye, with | [[File:Gray896.png|thumb|Anterior view of the right eye, with lacrimal duct shown medial.]] | ||
[[File:eyelid glands.png|thumb]] | [[File:eyelid glands.png|thumb]] | ||
*Chronic inflammatory lesion | *Chronic, sterile, granulomatous inflammatory lesion from blockage of a meibomian (or Zeis) gland | ||
*Also known as meibomian gland lipogranuloma | *Also known as meibomian gland lipogranuloma | ||
*Often | *Often develops from a healing [[hordeolum]] (stye) | ||
*More common on upper eyelid (higher density of meibomian glands) | |||
*Risk factors: [[blepharitis]], [[rosacea]], seborrheic dermatitis | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:Chalazion.jpg|thumb|Chalazion of right eye]] | [[File:Chalazion.jpg|thumb|Chalazion of right eye]] | ||
*Eyelid swelling | *Eyelid swelling initially may be tender, evolving into a '''painless, rubbery, well-circumscribed nodule''' | ||
* | *Not erythematous or warm (unlike acute hordeolum) | ||
*Points toward conjunctival surface (can see on lid eversion) | |||
*May cause [[astigmatism]] or visual disturbance if large enough to compress the cornea | |||
*'''Key distinction from hordeolum:''' Chalazion is painless and chronic; hordeolum is acute, tender, and often has a pointing pustule | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Periorbital swelling DDX}} | {{Periorbital swelling DDX}} | ||
*'''Sebaceous gland carcinoma:''' Consider in recurrent chalazia in the same location, especially in elderly patients — refer for biopsy | |||
==Evaluation== | |||
*Clinical diagnosis — no imaging or labs needed | |||
*Evert eyelid to visualize the granuloma from the conjunctival side | |||
==Management== | ==Management== | ||
*Discontinue eye makeup and | *Discontinue eye makeup and contact lenses until resolved | ||
* | *Warm compresses × 15 minutes QID with gentle eyelid massage | ||
*Antibiotics '' | *'''Antibiotics are NOT indicated''' (this is a granulomatous condition, not an infection) | ||
*Most resolve | *Eyelid hygiene with dilute baby shampoo scrubs | ||
*Most resolve spontaneously over weeks to months | |||
*Persistent cases: ophthalmology referral for intralesional steroid injection or incision and curettage | |||
==Disposition== | ==Disposition== | ||
* | *Discharge with warm compress instructions | ||
*Ophthalmology referral if persistent >6 weeks, recurrent, or concern for malignancy | |||
==See Also== | ==See Also== | ||
*[[Hordeolum]] | *[[Hordeolum]] | ||
*[[Blepharitis]] | |||
*[[Preseptal cellulitis]] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Ophthalmology]] | [[Category:Ophthalmology]] | ||
Latest revision as of 01:25, 21 March 2026
Background
- Chronic, sterile, granulomatous inflammatory lesion from blockage of a meibomian (or Zeis) gland
- Also known as meibomian gland lipogranuloma
- Often develops from a healing hordeolum (stye)
- More common on upper eyelid (higher density of meibomian glands)
- Risk factors: blepharitis, rosacea, seborrheic dermatitis
Clinical Features
- Eyelid swelling initially may be tender, evolving into a painless, rubbery, well-circumscribed nodule
- Not erythematous or warm (unlike acute hordeolum)
- Points toward conjunctival surface (can see on lid eversion)
- May cause astigmatism or visual disturbance if large enough to compress the cornea
- Key distinction from hordeolum: Chalazion is painless and chronic; hordeolum is acute, tender, and often has a pointing pustule
Differential Diagnosis
Periorbital swelling
Proptosis
- Normal IOP
- Orbital cellulitis
- Orbital pseudotumor
- Orbital tumor
- Increased IOP
- Retrobulbar abscess
- Retrobulbar emphysema
- Retrobulbar hemorrhage
- Ocular compartment syndrome
- Orbital tumor
No proptosis
- Periorbital cellulitis/erysipelas
- Dacryocystitis (lacrimal duct)
- Dacryocele/Dacryocystocele
- Dacryostenosis
- Dacryoadenitis (lacrimal gland)
- Allergic reaction
- Nephrotic Syndrome (pediatrics)
Lid Complications
- Blepharitis (crusts)
- Chalazion (meibomian gland)
- Stye (hordeolum) (eyelash folicle)
Other
- Subperiosteal abscess
- Orbital abscess
- Cavernous sinus thrombosis
- Conjunctivitis
- Contact dermatitis
- Herpes zoster
- Herpes simplex
- Sarcoidosis
- Granulomatosis with polyangiitis
- Sebaceous gland carcinoma: Consider in recurrent chalazia in the same location, especially in elderly patients — refer for biopsy
Evaluation
- Clinical diagnosis — no imaging or labs needed
- Evert eyelid to visualize the granuloma from the conjunctival side
Management
- Discontinue eye makeup and contact lenses until resolved
- Warm compresses × 15 minutes QID with gentle eyelid massage
- Antibiotics are NOT indicated (this is a granulomatous condition, not an infection)
- Eyelid hygiene with dilute baby shampoo scrubs
- Most resolve spontaneously over weeks to months
- Persistent cases: ophthalmology referral for intralesional steroid injection or incision and curettage
Disposition
- Discharge with warm compress instructions
- Ophthalmology referral if persistent >6 weeks, recurrent, or concern for malignancy