Chalazion

5 mins read

Introduction
A chalazion is a benign, painless bump or nodule inside the upper or lower eyelid caused by inflammation and obstruction of sebaceous glands within the eyelid. This bump may increase in size over days to weeks resulting in red, swollen eyelids.

Pus and blocked fatty secretions (lipids) that normally help lubricate the eye remain present in the chalazion and can no longer drain out.

Types
Depending on the glands infected and blocked, chalazion can be further categorized as either superficial or deep.

Meibomian gland inflammation leads to a deep chalazion, whereas of a Zeis gland leads to a superficial chalazion.

Causes

  • Poor hygiene of lid
  • Seborrheic Dermatitis – mainly affects the scalp and causes scaly patches, red skin and stubborn dandruff.
  • Acne rosacea– characterized by facial redness and swollen bumps under the skin (papules and pustules). It affects eyelids, conjunctiva, cornea and sclera.
  • Chronic Blepharitis – is characterized by chronic inflammation of the eyelid.
  • High blood lipid concentrations
  • Leishmaniasis

Epidemiology

Age-Related Demographics
It occurs in all age groups, but is more common in adults, especially people with age of 30-50 years than in children. Increase sebum viscosity because of androgenic hormones is presumed to cause this. At the time of puberty and during pregnancy, hormonal influences on sebaceous secretion and viscosity explains the clustering.

Sex- And Race-Related Demographics
Chalazion affect male and female equally, however, precise information about prevalence and incidence is not available. As per popular belief, cosmetic products increase the risk or worsen the situation, is not supported by any evidence.

Symptoms
The common symptoms of a chalazion are:

  • Hard lump on eyelid
  • Increased watering of the eyes
  • Impaired vision, blocked or blurred vision due to deposition of pus and other secretions.
  • Sensitivity to light
  • Irritation in eye due to persistent drainage and swelling.

Diagnosis
Chalazion can be diagnosed by having a look at the eyelid and the hump. Further questions will be asked by the doctor about symptoms to determine whether the lump is a chalazion, a stye, or something else.

Chalazia vs. Styes
Chalazia are different from styes however, sometimes chalazia is confused with styes. They can be easily differentiated from each other as chalazia do not usually hurt, while styes often do. Another symptom which helps in differentiating both is, while styes are most often found right on the eyelid edge, chalazia are usually found away from the edge of the eyelid.

Prevention
Individuals with thicker Meibomian gland secretions than others, have a greater risk of developing a chalazion. People infected once, are at higher risk of having chalazion again in future.  An easy way to prevent the clogging of Meibomian glands is the regular use of warm compresses, applied to the closed eyelids for five minutes before bedtime. Warm compresses and careful cleansing of the lid margins can be helpful for prevention of chalazion in people with seborrhea of the lids and recurrent chalazia. Recurrent chalazia people can benefit from chronic use of oral low-dose tetracycline as it changes the metabolism of the oil-producing glands and thus prevents the clogging of glands.

Treatment

Home Care
Warm compresses for five to 10 minutes for four times a day, helps in reducing swelling and promote drainage of the gland by softening the hardened oil that is blocking the duct.

Medication

  1. Antibiotic eye-drops or ointments are prescribed if a bacterial infection is suspected to be present in the eye lids.
  2. Inflammation in the area of hump can be prevented by giving steroid injections in that area.

Surgery
When chelation lasts for weeks or creates certain symptoms, then, it may need to be surgically removed.

Depending on its texture, the excision procedure varies. While fluid can easily be removed under minimal invasion merely by puncturing the chalazion and then applying pressure upon the surrounding tissue.

A larger incision is made usually to remove hardened matter, through that larger incision which can be scraped out. Regular application of dry heat also helps in the mobilization of the residual material inside the hump resulting in decrease of the size of the hump. Sometimes, excision of larger colors may result in deposition of blood around the eye lid  which lead to hematoma, which will wear off itself within three or four days. The swelling may persist for longer. Chalazion excision normally does not take longer than fifteen minutes.

Surgery is considered only as a last resort and is performed with as little as five percent of all patients.

Conclusion
Chalazion is most common inflammatory lesions of the eyelid caused due to obstruction of sebaceous glands. It can be diagnosed with a hard lump on eyelid resulting in redness and swelling of eyelids. It can be treated using mild medication (eye drops) and home care.

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References
1. Dhaliwal, U. and A. “A rationale for therapeutic decision-making in chalazia.”Orbit 4 (2005): 227-230.

2. Lederman C, Miller M. Hordeola and chalazia.Pediatr Rev. Aug 1999;20(8):283-4.

3. Sethuraman U, Kamat D. The red eye: evaluation and management.Clin Pediatr (Phila). Jul 2009;48(6):588-600.

4. Santa Cruz CS, Culotta T, Cohen EJ, Rapuano CJ. Chalazion-induced hyperopia as a cause of decreased vision.Ophthalmic Surg Lasers. Aug 1997;28(8):683-4.

5. Driver, Paul J., and Lemp, Michael A. “Meibomian Gland Dysfunction.”Survey of Ophthalmology 5 Mar. 1996: 343-367.

6. Khurana A, Ahluwalia B, Rajan C (1988). “Chalazion therapy. Intralesional steroids versus incision and curettage”.Acta Ophthalmol (Copenh) 66 (3): 352–4.

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