Chalazion - clinical fact sheet and MCQ

Overview

A chalazion is a chronic, non-infectious granulomatous inflammation of the eyelid caused by the obstruction of a meibomian gland and subsequent leakage of sebum into the surrounding tissues. This results in a painless, localised eyelid swelling that can persist for weeks to months. Chalazia are more common in adults though may occur at any age. They may arise secondary to blockage of the sebaceous glands of the eyelid caused by conditions such as blepharitis, ocular rosacea, or seborrhoeic dermatitis​. 

Diagnosis

A chalazion is diagnosed clinically - on history and physical examination. Patients with poor eyelid hygiene, or conditions that interfere with sebum composition, production, or drainage, may be more likely to develop chalazia. Such conditions include blepharitis, ocular rosacea, and seborrhoeic dermatitis.

Key features of chalazia include:

• non-tender, palpable nodule within the eyelid (typically 2-8 mm in diameter)

• no pain on eye movements, though there may be some degree of discomfort in the eyelid with movement of the globe

• absence of acute inflammation and minimal surrounding erythema

• may have associated blepharitis, ocular rosacea, or seborrhoeic dermatitis

Common differential diagnoses include:

• external hordeolum (stye): presents as a red, tender swelling on the eyelid margin, often with a visible pustule

• cyst of Zeis: a cyst arising from the sebaceous glands around the eyelashes; presents as a smooth, non-tender nodule filled with yellowish material on the eyelid margin

• basal cell carcinoma: the most common periocular malignancy; typically presents as a pearly, nodule with rolled edges, central ulceration, and visible telangiectasia on the lower eyelid

Red flags warranting ophthalmology referral include:

• pain with eye movements, reduced visual acuity, other ocular abnormalities such as proptosis and elevated intraocular pressure, and systemic symptoms such as fever and headache (consider orbital cellulitis)

• history of sinusitis of local skin trauma, diffuse oedema and significant erythema of the eyelid (consider preseptal cellulitis)

• visual disturbance or impacted eyelid function from large lesions, particularly in young children

• ulceration, destructive eyelid changes, telangiectasia, or persistent lesions (consider malignancy)

• recurring chalazia, particularly if in the same location on the eyelid (consider malignancy)

Management

Most chalazia resolve spontaneously within 6 months, but conservative management can be helpful in accelerating resolution:

• warm compresses and lid massage: 4-5 times daily for 10-15 minutes to promote sebum drainage 

• lid hygiene: gentle cleaning with diluted baby shampoo twice daily

• avoid squeezing or “popping” the chalazion as this could lead to infection or damage of the eyelid tissues

Chalazia are non-infectious and do not respond to antibiotics; antibiotics are not indicated unless there is a risk of secondary infection.

Consider ophthalmology referral if:

• the chalazion is very large or persistent (>2 months): to evaluate the suitability for corticosteroid injection or incision and curettage

• malignancy is suspected: 

• Ulceration or induration

• destructive changes of the eyelid margin

• recurrent chalazia in the same location

• madarosis (eyelash loss)

• irregular borders of the lesion

• telangiectasia

• reduced sensation

• young children with large chalazia that is causing visual disturbance should be referred to ophthalmology due to the risk of amblyopia

To minimise recurrence of chalazia, the patient may be advised to engage in diligent hygiene, including regular face washing, contact lens care, and hygienic use of cosmetics.

References 

Stokkermans TJ, Prendes M. Benign Eyelid Lesions. 2023. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK582155/.

Sun MT, Huang S, Huilgol SC, et al. Eyelid lesions in general practice. AJGP. 2019;48(8):509-514. doi: 10.31128/AJGP-03-19-4875.

BMJ Best Practice. Stye and chalazion. 2024. Available at: https://bestpractice.bmj.com/topics/en-gb/214. (last viewed January 2025). 

Willmann D, Guier CP, Patel BC, et al. Hordeolum (Stye) [Updated 2024 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459349/. (last viewed January 2025).

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