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

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

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

Non pharmacological

A proportion of chalazia resolve on conservative management (warm compresses and lid massage; may take weeks or months)
If large, recurrent or causing corneal distortion then refer for management by ophthalmologist. More invasive therapies, such as incision and curettage or steroid injections should be considered for chalazia that have been present for more than 2 months, as older lesions are less likely to resolve with conservative therapies alone.
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 large, recurrent, or causing corneal distortion

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 (see https://www.gradeworkinggroup.org/)

Sources of evidence

Aycinena AR, Achiron A, Paul M, Burgansky-Eliash Z.Incision and Curettage Versus Steroid Injection for the Teatment 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(4):e503-e509

Plain language 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 in a minor operation under local anaesthetic.

 

Chalazion (Meibomian cyst)
Version 15
Date of search 27.07.20
Date of revision 31.07.20
Date of publication 23.04.21
Date for review 26.07.22
© College of Optometrists 

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