Aetiology

A chalazion is a chronic lipogranulomatous lesion affecting the upper or lower eyelid, caused by blockage of Meibomian gland duct(s) with retention and stagnation of secretion.

May occur spontaneously or follow an acute hordeolum (internal)

Predisposing factors

Chronic blepharitis
Rosacea
Seborrhoeic dermatitis
Pregnancy
Diabetes mellitus

Symptoms of chalazion (meibomian cyst)

Painless lid lump
Usually single; sometimes multiple
May be recurrent
May rupture through the skin
(Sometimes) blurred vision from induced astigmatism (typically against the rule or oblique). Large or multiple chalazia involving the whole upper eyelid carry the greatest risk of inducing a change in corneal topography

Signs of chalazion (meibomian cyst)

Well-defined, 2-8mm diameter subcutaneous nodule in tarsal plate
Lid eversion may show external conjunctival granuloma
Induced astigmatism/hyperopia may cause change in refraction (particularly if large or in children). Large chalazia may also obscure vision or impact on eyelid closure.
May be associated blepharitis

Differential diagnosis

Hordeolum (external or internal)
Sebaceous cyst of skin
Meibomian gland carcinoma (consider if lesion recurrent)

Management by optometrist

Practitioners should recognise their limitations and where necessary seek further advice or refer the patient elsewhere

GRADE* level of evidence and strength of recommendation always relates to the statement(s) immediately above

Many chalazia resolve within 6 months with conservative management (warm compresses (at least 40-45°C for 10 mins) and lid massage).
If large, recurrent, causing corneal distortion or interfering with eyelid function, refer for management by ophthalmologist. 

More invasive therapies, such as incision and curettage or steroid injections could be undertaken by appropriately trained optometrists for persistant chalazia, as older lesions are less likely to resolve with conservative therapies alone. However, these procedures should be undertaken in a suitable clinical setting to prevent cross-infection and mechanisms need be in place to access the required parenteral medicines.

When undertaking invasive procedures, optometrists should ensure that appropriate medical malpractice (professional indemnity) insurance and clinical governance arrangements are in place and the College of Optometrists guidance on expanded scope of practice is followed.

Regular lid hygiene for blepharitis (see Clinical Management Guideline on Blepharitis)

(GRADE*: Level of evidence=low; Strength of recommendation=strong)

None (but see Clinical Management Guideline on Hordeolum [internal])

Management category

B2: alleviation/palliation: normally no referral
B1: routine referral to ophthalmologist if chalazia are large, recurrent, or interfering with visual function. 

Possible management by ophthalmologist

Incision and curettage where appropriate
Intra-lesion injection of steroid (may be preferred in children)
Trials have indicated uncertainty as to the relative benefits of intralesional triamcinolone injection compared with incision and curettage 

Evidence base

*GRADE: Grading of Recommendations Assessment, Development and Evaluation (www.gradeworkinggroup.org)

Sources of evidence

Aycinena AR, Achiron A, Paul M, Burgansky-Eliash Z. Incision and Curettage Versus Steroid Injection for the Treatment of Chalazia: a Meta-Analysis. Ophthalmic Plast Reconstr Surg. 2016;32(3):220-4

Ben Simon GJ, Rosen N, Rosner M, Spierer A. Intralesional triamcinolone acetonide injection versus incision and curettage for primary chalazia: a prospective, randomized study. Am J Ophthalmol. 2011;151(4):714-718

Goawalla A, Lee V. A prospective randomized treatment study comparing three treatment options for chalazia: triamcinolone acetonide injections, incision and curettage and treatment with hot compresses. Clin Exp Ophthalmol. 2007;35(8):706-12

Jin KW, Shin YJ, Hyon JY. Effects of chalazia on corneal astigmatism : Large-sized chalazia in middle upper eyelids compress the cornea and induce the corneal astigmatism. BMC Ophthalmol. 2017;17(1):36.

Ouyang L, Chen X, Pi L, Ke N. Multivariate analysis of the effect of Chalazia on astigmatism in children. BMC Ophthalmol. 2022;22(1):310.

Perry HD, Serniuk RA. Conservative treatment of chalazia Ophthalmology 1980;87(3):218-21

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

Wu AY, Gervasio KA, Gerdoudis KN, Wei C, Oestreicher JH, Harvey JT. Conservative therapy for chalazia: is it really effective? Acta Ophthalmol. 2018; 96(4):e503-e509

Chalazion (Meibomian cyst)
Version 16
Date of search 23.10.22
Date of revision 26.01.23
Date of publication 20.02.23
Date for review 22.10.24
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