Chalazion (Meibomian cyst)

The CMGs are guidelines on the diagnosis and management of a range of common and rare, but important, eye conditions that present with varying frequency in primary and first contact care.

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Aetiology

Blockage of Meibomian gland duct 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

Painless lid lump

Usually single; sometimes multiple

May be recurrent

May rupture through the skin

(Sometimes) blurred vision from induced astigmatism

Signs

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

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

Non pharmacological

May resolve on conservative management (warm compresses and lid massage; may take weeks or months)

If persistent, large, recurrent or causing corneal distortion then refer for management by ophthalmologist

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

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

Pharmacological

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

Management category

B2: alleviation/palliation: normally no referral
B1: routine referral to Ophthalmologist if persistent or recurrent, if causing significant astigmatism or if cosmetically unacceptable 

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.gradingworkinggroup.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

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:e503-e509

Lay summary

A chalazion, also known as a Meibomian cyst, is a common condition of the eyelid caused by blockage of the openings of the oil-producing Meibomian glands. It is usually felt as a small firm lump in the upper or lower eyelid. The condition usually gets better with a combination of warm compresses and massage. However if it does not settle, it can be treated by a steroid injection or the cyst can be removed by a minor surgical procedure.

 

Chalazion (Meibomian cyst)
Version 14
Date of search 17.07.18
Date of revision 20.07.18
Date of publication 20.12.18
Date for review 16.07.20
© College of Optometrists 

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