Dr Ben Wild
Overview |
The lacrimal system of the eye (tissues associated with producing your tears) includes the lacrimal gland and Meibomian glands along with many other components. The lacrimal glands create the watery portion of the tears and the Meibomian glands, about 40 tiny glands per eyelid, create a protective lipid/oil layer that sits above the watery layer.
A chalazion is a Meibomian or Zeiss gland cyst filled with inflammatory cells and oily secretions. These cysts can turn into large nodules that produce discomfort and can lead to decreased vision. If left untreated these nodules can solidify. A hordeolum is a chalazion that is infected and tends to be much more painful.
A frontal view of a normal eye (top) and another frontal view of a large chalazion on the upper lid (bottom)
Signs and Symptoms |
Signs
Red to yellow nodule on the inside of the eyelid or on the eyelid margin.
Symptoms
Localized discomfort, discomfort when blinking, localized heat, if infected (hordeolum) it will be quite tender to the touch, decreased vision if large enough.
Causes and Risk Factors |
Causes
Inflammation of the eyelids (blepharitis) leading to thickened oil secretions, and finally, plugged meibomian glands.
Risk Factors
Seborrhea, acne rosacea, constantly rubbing eyes with dirty hands.
Prevention and Treatment |
Prevention
Treat the blepharitis before a chalazion occurs with proper lid hygiene. If the blepharitis is chronic, a prophylactic oral tetracycline can help if linked to rosacea.
Treatments
Treatments aim at unblocking the meibomian gland and removing its solidified contents.
· Small: tend to resolve on their own (1/3 cases)
· Small to moderate: Lid hygiene with a good skin cleanser that does not burn the eyes (Blephaclean or Cetaphil) followed by 10 minutes of heat applied to the eyelid followed by massaging the eyelid from the base of the lid to the eyelid margin several times a day.
· Moderate to large with possibility of infection: same as described in small to moderate but a topical or oral antibiotic may also be prescribed.
· Chronic/long standing: steroid injection or incision and manual removal of contents
Prognosis |
About 1 in 3 cases resolve on their own. Others require about a month of lid hygiene, warm compresses and lid massage, and very few actually require steroid injections (which successfully treat 80% of stubborn cases) or incisions. They typically do not lead to permanent vision loss however, some causes of chalazions/hordeolum can cause vision loss.