Chalazion (Meibomian cyst)

What is a chalazion?

A chalazion (otherwise known as a Meibomian cyst) is a firm swelling in the eyelid due to chronic inflammation of the oil-producing glands (Meibomion glands) located in the upper and lower eyelids. These glands normally secrete the oily (sebaceous secretions) layer of the tear film.

Chalazia are a common problem and can occur in any age group. They are more common in adults than children. Hormonal influences on sebaceous secretions may explain a slight increased incidence during puberty and during pregnancy.

What causes a chalazion?

Chalazia occur when the openings of the Meibomian glands onto the eyelid margin become blocked. This leads to trapping of the sebaceous secretions of the glands within the eyelid, which then becomes chronically inflamed. This results in a firm and usually painless inflammatory lump within the eyelid itself.

Patients prone to developing chalazia often have chronic dysfunction of their Meibomian glands. This leads to abnormal thickening of the sebaceous secretions, and when the eyelid is squeezed, toothpaste-like matter is seen rather than healthy clear oily secretions. Patients often have blepharitis (see Information sheet on Blepharitis) or inflammation of the eyelid margin.

Chalazia are not usually due to poor eyelid hygiene or the application of eye make-up.

How is it different from a Stye?

Chalazia are occasionally confused with Styes, which can also appear as a lump on the eyelid. However, Styes are due to acute bacterial infection at the base of an eyelash follicle and present as more painful lumps closer to the edge of the eyelid.

How do I know I have a chalazion?

Chalazia most often present as painless firm lumps within the upper or lower eyelid. They are often easier to feel than see. Sometimes they present as areas of redness close to the eyelid margin (marginal chalazion). Occasionally, if the trapped sebaceous secretions within the eyelid become infected, a chalazion can present as a tender red swelling of the whole eyelid. Patients may develop several chalazia at the same time in different eyelids.

Chalazia may spontaneously “burst” and release a thick mucoid discharge into the eye. They often “point and release” this discharge toward the back of the eyelid, rather than through the skin, and often reform again. They can persist for weeks to months in some patients.

Chalazia rarely cause visual problems and are not a threat to the eye itself. However, if very large, they can cause visual disturbance.

Your ophthalmologist will diagnose a chalazion by examination of your eyelids in fine detail under the slit lamp microscope.

How can I treat a chalazion?

Small chalazia that are not causing symptoms will often disappear on their own, or with the following simple treatment:
1.Warm compresses
2.Regular eyelid massage

The warmth of the compresses will melt any trapped oily secretions, and the mechanical action of the eyelid massage will help dislodge any thickened secretions from gland openings, as well as encourage movement of trapped secretions out of the eyelid.

Technique of warm compresses and eyelid massage:

• First, apply a warm moist towel onto the eyelids for 5-10 mins.
• Whilst the eyelids are still warm, use your index finger to firmly massage over any eyelid lump in a direction TOWARD the eyelid margin (where the eyelashes are). That is, for upper eyelid lumps, massage DOWN toward the eyelid margin, and for lower eyelid lumps, massage UP toward the eyelid. Apply 10 strokes in each massage, and repeat 4 times per day.

Preventative warm compresses and eyelid hygience:

Once your chalazia has resolved or been treated, continuing the warm compresses and paying attention to eyelid hygiene can help prevent any future recurrence. This is performed as follows:

• Apply a warm moist towel onto the eyelids for 5-10 mins
• Whilst the eyelids are still warm, apply a drop of baby shampoo onto fingertips or a cotton bud and work up a lather. Close your eyes and rub your index finger or cotton bud across the eyelid margins in a horizontal to-and-fro fashion for 10 strokes. Then thoroughly rinse the eyelids. This should be done twice per day.

What if simple treatment does not work?

In some cases, chalazia will persist despite warm compresses and massage.
If they are large and symptomatic, then your ophthalmologist will perform a simple procedure to drain the chalazia. This can often be done in the office under local anaesthetic.

Technique of surgery:

A small amount of anaesthetic will be injected into the skin of the eyelid over the lump.
A small eyelid clamp will be used to allow access to the undersurface (back surface) of the eyelid, and an incision made through the undersurface of the lump. A fine curette is then used to gently clean and remove the inflamed secretions. No sutures are required. Antibiotic ointment is placed in the eye and an eye pad is worn for a few hours after.

As no cuts are made into the skin of the eyelid, there is no visible scarring from this procedure. After the procedure, the eye may feel gritty or have a mild foreign-body sensation in it for a few days. You are given an antibiotic ointment to put in the eye for 1 week, and continue to apply warm compresses and massage. You are generally reviewed 2-3 weeks after the procedure.

Occasionally, chalazia may still recur after this procedure. But with long-term application of warm compresses and eyelid hygiene, this risk is greatly reduced.

What other treatments are used?

Steroid injections or ointments:

If chalazia are very inflamed (red and swollen), then the injection of steroid (anti-inflammatory) medication into the chalazia can greatly hasten resolution, and sometimes allow surgery to be avoided. This procedure is done in the office. The steroid is injected with a fine needle (after the application of a local anaesthetic injection), and lasts about 1 month. There is very little risk with this procedure. Rarely, it may cause depigmentation of the skin of the eyelid, in darker-skinned patients. Very rarely, it can lead to raised eye pressures.

Steroid eye ointments are occasionally useful to help reduce severe eyelid inflammation, which will encourage drainage of trapped secretions and provide symptomatic relief. However, they should only be applied for a short course and under supervision. Long-term unsupervised use can lead to eye complications, particularly raised eye pressure.

Antibiotics:

As this is not an infection, antibiotics do not play a large role in the treatment of chalazia. Antibiotic eye drops are not useful, and may actually cause unnecessary side effects.
Some patients with significant Meibomian gland dysfunction or posterior blepharitis may benefit from a 6-12 week course of low-dose doxycycline tablets, to help reduce inflammation and recurrence.

What if the chalazion keeps coming back?

Any eyelid lump which persists or keeps coming back, despite proper treatment, must be treated with suspicion. In rare cases, certain eyelid tumours, particularly sebaceous carcinoma (tumour of the Meibomian glands) can mimic a chalazion. If your ophthalmologist suspects this, then a biopsy of the eyelid will be performed to investigate for this.

Always consult your ophthalmologist if your “chalazia” does not go away.