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 may cause change in refraction
  • May be associated blepharitis

Differential diagnosis

  • Hordeolum (external or internal)
  • Sebaceous cyst of skin
  • Sebaceous (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
  • Usually (up to 80%) resolves spontaneously (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 shown that intralesional triamcinolone injection may be as effective as incision and curettage in primary chalazia (see evidence base) 

Evidence base

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

Sources of evidence

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

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 without treatment. However if it does not settle on its own, it can be treated by a steroid injection or the cyst can be removed by a minor operation.

 

Chalazion (Meibomian cyst)
Version 13
Date of search 24.04.16 
Date of revision 13.06.16
Date of publication 17.10.16
Date for review 23.04.18
© College of Optometrists 

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