Chalazion

What is a chalazion?

A chalazion (kal-az-ion) forms when one of the meibomian or tarsal glands of the eyelid becomes blocked. The oily contents it normally releases into the tear film instead build up within the eyelid, forming a cyst. This is initally tender, and may become very inflamed. This inflammation is caused by sensitivity to common bacteria found on the skin. Many chalazia resolve spontaneously, or sometimes discharging through the skin. This may however take many months.

What are the signs and symptoms?

A hard, localised swelling appears on the upper or lower eyelid, occurring over a few weeks. It may be tender and the eyelid may appear red, if it is infected. Rarely the chalazion can become big enough to block a small part of your field of vision or press on the eyeball causing blurred vision.

How is it diagnosed?

We can diagnose it by examining the back of the eyelid and the eye itself.

What treatments are available?

Hot bathing and lid hygiene may prevent a chalazion forming if started in the early stages of the condition, but once fully formed, incision and curettage is the only means of removing a chalazion. It can be done quickly in the out-patient clinic, under local anaesthetic.

The first stage of treatment involves using a warm compress and massaging your eyelid:

  • It will help soothe your eye, making it feel more comfortable.
  • It will allow the natural oils in the skin and eyelid to flow more freely, helping to reduce the size of the cysts and prevent any further swelling
  • It can be used as a sort of “first aid” treatment if you are unable to get to your GP surgery or to us quickly.
  • It is effective and very easy to do

Warm compress:

  • You will need some hot water, a bowl and some cotton wool. It will help if you can find a quiet place where you wont be disturbed or where the bowl of water may not get knocked over.
  • Boil some water and let it cool a little or use water from the hot tap. It should be fairly hot but not so hot that it will burn you. Soak cotton wool or a clean flannel in the warm (but not boiling) water, squeeze it out and gently press onto your closed eyelids for two to three minutes at a time.
  • Massage: Starting at the skin crease, gently massage the upper lid downwards to the lashes. The lower lid is massaged upwards towards the lashes. This may release the contents of the cyst, which means further treatment is not necessary.
  • You may also be prescribed antibiotics to reduce the inflammation in the eyelid

Applying moist heat to the eyelids can help – this is called ‘hot spoon bathing’. The heat helps to relieve pain and encourages the lump to discharge.

Alternatively you can use a product called “Eye Bag” which is an eye mask filled with flax seeds. This is heated up in the microwave and is effective at transferring heat. It has an extra advantage in that it can be re-used up to 200 times for patients who experience recurrent problems and need to use regular heat treatment.

What if hot spoon bathing does not work?

If the lump grows and is does not respond to heat massage you may need a small surgical procedure called ‘incision and curettage.

The second stage of treatment

If your chalazion persists, we can offer you an incision and drainage under a local anaesthetic.

Benefit of surgery

The inflamed chalazion will be drained.

Risks

  • Your eyelid might be swollen and bruised for several days, but should have settled completely by two weeks after your operation.
  • There is a risk of infection, but you will be given antibiotic ointment to use after the operation.
  • A chalazion can come back. If it does, please apply a warm compress to your closed eyelid and treat as below.

Do contact us if your chalazion persists even after you have attempted treatment. Further ophthalmic treatment and investigation may be required.

The procedure

Meibomian cysts will very often get better by themselves after several months. If it does not, a minor operation called “Incision and Curettage” (I&C) can help.  It only takes a few minutes:

We will explain the procedure again before they start operating. Once you are lying comfortably on a couch, local anaesthetic drops are put in your eyes to numb them. The eyelids are cleaned with an iodine-containing antiseptic solution the skin around the chalazion will be injected with local anaesthetic. This will sting at first but the lid will soon become numb. Although you will still be able to feel touch and pressure you should not feel any pain.  We will make a small incision on the inner surface of your eyelid so that the contents of the cyst can be drained. In most cases the contents of the cyst are discarded. Occasionally the contents of the cyst are sent to the pathology laboratory for microscopic checks to make sure that it is harmless; this is a “biopsy”.

You will not need stitches and no scar will be visible.

At the end of the operation antibiotic ointment will be applied and a pad placed over the eye. You will be given the ointment to use at home, usually three times a day for one week. Usually no more appointments are required and you will be able to go home on the same day.

If we take a biopsy of the cyst,  we will telephone you with the results or will send a clinic appointment if required.

Aftercare and advice

When the anaesthetic wears off, there may be some discomfort. You may find mild pain relief such as paracetamol helpful. You should keep the pad over the eye for at least four hours as this reduces the swelling and bruising. You may find some blood and discharge in and around your eye. This is quite normal and can be removed by bathing the lids gently with cool boiled water.

The eyelid may look bruised and swollen for a few weeks after the operation. You should not wear contact lenses until the eye feels normal again.

Infection is rare. Often the lid is thickened and inflamed around the cyst, this thickening may take a few weeks to settle even after incision and curretage.

Please continue to use the antibiotic ointment 4 times daily for a further week.

Incising the chalazion is a minor procedure and does not involve surgery on the eye only the eyelid. It should not affect your ability to work.

What are the Do’s and Don’ts

  • Swimming: No swimming until two weeks after surgery. If you must swim before then, then watertight goggles should be worn.
  • Bath/shower/hair wash: You can have a bath, shower or wash your hair, but avoid soap or shampoo to the eye as you would normally do.

What happens if I do not get treatment?

Sometimes the lump disappears or shrinks by itself without treatment being needed.

However, without treatment the lump may enlarge and the affected lid could swell – this could lead to more discomfort.

What should I do if the symptoms get worse?

You must call us or attend your local eye casualty for further help.

What happens after the operation?

You should not drive home after the operation so please come to hospital by public transport or arrange for someone to drive you home.

Rarely the cyst may seem to persist after the operation. Usually this is because another one has started to form. In this case you should contact the hospital and arrangements will be made to see you again.

What are the risks of surgery?

Your eyelid might be swollen and bruised for several days after your operation but this should settle after two weeks.

There is a risk of infection, but after the operation you will be given antibiotic ointment to apply, which should help prevent this.

A chalazion can come back after being removed. If this happens, please apply a warm compress to your closed eyelid.

When should I seek advice?

If your sight becomes blurred or you experience bleeding, you should call us immediately.

How do I prevent further Chalazia?

Chalazia may recur, or may form in other eyelids or parts of the same eyelid.

Sometimes a cyst will develop because of an underlying lid or skin problem e.g. blepharitis, acne. Treating this condition may help to prevent further cysts developing.

  • To prevent a chalazion from developing, daily lid cleaning is recommended as follows: Warm compress: Boil some water and let it cool for a while. Soak cotton wool or a clean flannel in the warm (but not boiling) water, wring it out and gently press onto your closed eyelids for two/three minutes at a time.
  • Massage your eyelids by gently rolling your first finger over them in a circular motion. This helps to push out the oil from the tiny eyelid glands.
  • Use a cotton bud to gently clean the edge of your lower lid: Pull the top lid away from your eyeball while looking in a mirror, and clean the edge gently with the cotton bud. Wipe your eyes with clean water afterwards.

Repeat this routine once or twice every day to prevent further flare-ups.

If you feel another cyst is developing, use hot flannels on your eyelid or hold your closed eye over a bowl of steaming hot water. This helps the pores in the eyelid to open up and for the grease to drain out. Take care not to burn your eyelid with the hot water. Do this several times a day, for a few days.

Brolene ointment from your chemist or antibiotic ointment from your doctor will help to reduce infection in and around the cyst. If you have several cysts and have blepharitis, tetracycline tablets from your doctor may help them to clear.