Overview
A chalazion is a chronic noninfective inflammation of the sebaceous glands of the eyelid that affects the meibomian glands in the tarsal plate. Clinically, it results in a painless, firm nodule of the eyelid. Marginal chalazia are caused by inflammation of the gland of Zeis located at the lid margin. They can affect both the upper and lower lids. Acne rosacea and posterior blepharitis are commonly associated with chalazion. Hyperimmunoglobulinemia E (Job syndrome) can be associated with aggressive chalazion.
Meibomitis predisposes to the formation of chalazion; the inflammation leads to blocking of the duct opening, resulting in clogging of the secretions and then swelling. This results in a chalazion and hardening of secretions with time. Chalazion is a noninfective condition. However, it can become infected and acutely inflamed, causing a tense, warm lid swelling called hordeolum internum. This is how meibomitis is linked to the pathogenesis of chalazion formation and recurrence.
On histological slides, it appears as deep dermal or subcutaneous suppurative lipogranulomatous inflammation containing neutrophils, plasma cells, lymphocytes, histiocytes, and giant cells in a zonal configuration around central lipid material. A pseudocapsule surrounds the cellular infiltrate.
Many chalazia resolve within 2 weeks of a topical antibiotic and steroid medication and application of warm compresses.
These aid in reducing inflammation and increasing the local blood supply.
Incision and curettage is a conventional and effective treatment of chalazion (see the image below).
Photograph of a left lower lid chalazion.
In cases of multiple chalazia with no evidence of infection, local intralesional injection of triamcinolone may cause regression of the chalazion within a few weeks.
It can also be used as an alternative to standard surgical procedure.