Chalazion: definition, symptoms, diagnosis and treatment

By Cristiano Antonino Last updated Apr 13, 2023

The chalazion is a rather common disorder that can affect the eyes and appear externally as a kind of furuncle on the upper or lower eyelid

It is caused by an inflammation of the meibomian glands, i.e. the glands responsible for the production of the lipid component of tears; the inflammation can cause an obstruction of the tear ducts with an accumulation of secretion, which then leads to the formation of a small nodule in the eyelid, characterized by swelling and erythema.

In most cases it is a minor disorder, which can be treated with eyelid hygiene and some medications, however in the most serious cases it may be necessary to intervene surgically to remove it.

What is a chalazion

A chalazion is a cyst, or more precisely a lipogranuloma, which can form on the upper or lower eyelid of the eye, due to chronic non-infectious inflammation of the meibomian sebaceous glands.

It can form externally on the skin surface, called supratarsal chalazion, or be located deeper in the back of the eyelid, called subtarsal chalazion.

When more than one meibomian gland is inflamed, it is called chalazion.

The formation of a chalazion usually occurs suddenly: in the preceding days the patient may feel a slight discomfort or an itchy sensation in the affected area, up to the appearance of a small nodule, hard to palpation, characterized by swelling of the eyelid at the inflamed gland, erythema and swelling.

It can be both an acute problem and a chronic disorder, and if it reaches particularly large dimensions it can lead to astigmatism due to compression on the cornea or blurred vision.

The secretion at the origin of the inflammation can come out in the form of pus, favoring the reabsorption of the chalazion within a few weeks; however, if the purulent material remains encysted, surgery may be necessary to remove it.

To understand the causes that can lead to the formation of a chalazion, it may first be useful to review the anatomy of the eyelids and the function of the meibomian glands.

What are the meibomian glands and what do they do?

Along the eyelids, each follicle of the eyelash margin is equipped with a gland of Zeis, responsible for the production of sebum.

In the same area, at the base of the eyelashes, there are also some sweat glands called Moll’s glands; along the inner margin, on the other hand, there are the meibomian glands, or tarsal glands, which have the function of secreting a dense lipid substance, which favors the mechanical sliding of the eyelids on the ocular surface.

The only exception to this structure is constituted by the medial portion of the eyelids, which instead is home to the lacrimal points, for the outflow of tears.

Occasionally, the accessory glands of the eyelids can be subject to bacterial invasion: when the infection affects a meibomian gland, a chalazion can form, while when the infection affects another sebaceous gland of the eyelashes or a lacrimal gland, a sty can arise .

What are the main causes of a chalazion?

As already anticipated, the onset of a chalazion is due to the obstruction of the tear ducts in correspondence with the meibomian glands: in fact, when there is inflammation in progress, the excretory ducts of the glands are obstructed and the lipid component produced fails to flow outwards, determining the characteristic nodular formation i.e. a granuloma; the accumulation of lipid material can cause redness, pain and inflammation in the soft tissues surrounding the affected gland, with associated inflammation of the conjunctiva.

The obstruction can also be due to the presence of foreign bodies inside the eye, or to alterations of the mebo itself (i.e. the ocular sebum).

Alterations can be caused by:

Eating disorders or an unbalanced diet, especially if characterized by an excessive consumption of sausages, fats and sugars;
Thyroid dysfunction and hormonal factors;
Intense stress or anxiety states;
Uncorrected visual defects;
Prolonged use of contact lenses;
Poor eye hygiene;
Oily skin or seborrhea;
Pre-existing eye infections;
Infectious diseases such as acne rosacea, eczema or chronic blepharitis;
Allergies;
Hereditary predisposition;
Intestinal tract disorders such as spastic colitis;

Symptoms and complications

Based on what has been said so far, the chalazion looks like a cyst that can be located internally or externally on both the upper and lower eyelids of the eye.

In general, the symptoms and their severity can vary greatly depending on the extent of the inflammation and the number of glands involved, but in most cases, patients do not complain of particularly severe symptoms.

The symptomatology of this disorder is characterized by the sudden appearance of swelling in the eyelid with consequent redness and hyperemia.

In the initial stages, the chalazion can cause soreness in the entire eye area, but the eyelid gradually tends to deflate after a few days; however, the formation of a cyst of variable size occurs, which can lead to discomfort and a foreign body sensation inside the eye for several weeks.

The main symptoms associated with this disorder are:

Eyelid swelling;
Inflammation and redness;
Feeling itchy;
Swelling in the area around the chalazion;
Photophobia;
Blurred vision;
eye redness;
Excessive secretion;
Blepharoptosis up to involving a total closure of the eye;
If the chalazion is associated with other pre-existing infections, crusts may form that cause itching and burning;

Normally the swelling on the skin tends to spontaneously drain the purulent material on the inner surface of the eyelid, or it is reabsorbed autonomously within 2 to 8 weeks.

However, some cysts tend to become chronic: in these cases, when the disorder persists for longer, it is necessary to intervene surgically to solve the problem.

Among the possible complications that can arise due to a chalazion are: inflammation of the conjunctiva, compression of the cornea and astigmatism.

A simple clinical examination by an ophthalmologist is usually sufficient for the diagnosis of a chalazion

Nevertheless, in the presence of suspicious symptoms or in the case of chronic chalazion that does not respond adequately to therapy, a more in-depth examination with a series of additional tests or a biopsy to investigate the nature of the cyst cannot be excluded.

However, the chalazion, especially during the first few days, can often be confused with a sty, another rather common eye disorder characterized by acute inflammation on an infectious basis.

Treatments and remedies to cure chalazion

In most cases, the disturbances caused by a chalazion tend to gradually resolve on their own, as the lipid plug causing the obstruction of the tear ducts is reabsorbed.

To treat the inflammation and facilitate resolution of the problem in a shorter time, the doctor can usually prescribe eye drops, ophthalmic ointments and ointments based on antibiotics and cortisone.

These drugs also help reduce swelling and drain the material inside the cyst.

To facilitate the healing process without resorting to pharmacological therapy, hot-humid compresses can be applied to the eyelids several times a day, in order to favor the drainage of the obstructed meibomian gland.

At the pharmacy, disinfectant wet wipes and wetting solutions are also available which help keep the eye hydrated and clean, relieving the discomfort caused by the chalazion.

On the other hand, for larger or more refractory chalazions, an outpatient surgery can be performed for the incision of the cyst: after local anesthesia, a small incision is made inside the eyelid through which a special tube is introduced to drain the pus (curettage of the chalazion), or to completely remove the gland causing the problem.

Alternatively, intralesional injection of corticosteroids can be used to intervene on acute inflammation.

During the course it is also essential not to use aggressive cosmetics or products, and to avoid applying contact lenses to avoid the risk of inducing microtraumas or corneal infections.

Finally, one must refrain from pressing, rubbing or squeezing the chalazion as more severe complications could occur.

How to prevent the onset of chalazion

In the case of patients who are particularly prone to the onset of chalazions, it is possible to follow some simple indications to prevent the formation of a cyst: first of all, it is advisable to always scrupulously apply the rules for personal hygiene, washing your hands often before touching your face and taking care to thoroughly clean any object that comes into contact with the eyes.

Following a balanced diet while avoiding excessive consumption of fatty foods and alcohol can bring substantial benefits.

For those who wear contact lenses, it is very important to make sure they are adequately disinfected before application, not to use monthly or annual lenses beyond the recommended limit and to opt for products with a high percentage of hydration.

If you are particularly prone to eye inflammation, a good rule of thumb is to cleanse the area daily with a cotton swab and take care to use neutral products, cosmetics and make-up removers that do not contain aggressive agents.

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