A chalazion (meibomian cyst) is a chronic, sterile, granulomatous inflammatory lesion caused by retained sebaceous secretion leaking from the meibomian or other sebaceous glands into adjacent stroma. A chalazion secondarily infected is referred as an internal hordeolum.

Clinical features:

Ø  A gradually enlarging painless nodule.

Ø  Very rarely a large upper lid chalazion may press on the cornea, induce astigmatism and cause blurred vision.

Ø  A ‘marginal’ chalazion is similar except that it involves a gland of Zeis and is therefore located not in the tarsal plate but on the anterior lid margin.

Ø  Patients with meibomian gland disease or rosacea are at increased risk of chalazion formation which may be multiple and/or recurrent.

Non- pharmacological treatment:

l  Treatment may not be required because at least a third of chalazia resolve spontaneously and an internal hordeolum may discharge and disappear. Persistent lesions may be treated as follows:

l  Dry hot fomentation applied frequently in early stage is useful.

Pharmacological treatment:

1.       Steroid injection into the lesion is preferable if close to the lacrimal punctum because of the risk of surgical damage.Between 0.2 and 2 ml of 5 mg/mL triamcinolone diacetate aqueous suspension diluted with lidocaine (or equivalent) to a concentration of 5mg/mL is injected through the conjunctiva into the tissue around the lesion with a 30- gauge needle.The success rate following one injection is about 80%. In unresponsive cases a second injection can be given 2 weeks later.

2.       Cap. doxycycline (100 mg BD for 7 days) may be required as prophylaxis in patients with recurrent chalazia, particularly if associated with acne rosacea.

3.       Incision and curettage, in case of large chalazia, if present for more than 3 – 4 months or if cosmetically unacceptable.

Patient education:

Recurrence may occur; common causes are uncorrected refractive error, blepharitis and diabetes.