ANATOMY: Oil glands (meibomian glands) are a normal structure of the eyelid. The oil glands add oil to to the tear film to make it more stable. There are about 20 oil glands in each of the four eyelids, and each oil gland has the potential to become a chalazion.
WHAT IS A CHALAZION? A chalazion is a chronically constipated oil gland (meibomian gland cyst) of the eyelid. The retained oil causes inflammation, but usually not an infection. Patients of all ages, from babies to senior citizens can get chalazia. Chalazia are a very, very, very common eyelid problem and can be multiple. They often enlarge and shrink spontaneously. They may be associated with a pinkish lump (granulation tissue or “pyogenic granuloma”) on the inside of the lid when they burst. It is not uncommon for a blood clot to fall out weeks after a chalazion has been expressed.
Chalazia are mainly a cosmetic problem, although they cause mild irritation, and at times make the eyelid to droop. Chalazia are sometines seen with blepharitis (“dandruff of the eyelashes”) A skin condition called ROSACEA is a common association with chalazion. (Hyperimmunoglobulinemia E causing multiple chalazia is exceedingly rare.) Occasionally, a persistent “chalazion” may imitate a skin cancer such as sebaceous carcinoma or basal cell carcinoma.
TREATMENT Some chalazia may resolve if you are willing to wait several months and use warm compresses. The natural history of chalazia however is to get bigger and smaller. Warm compresses and showers may help “melt” the oil secretion. To make a warm compress, place a kleenex or clean cloth in comfortably warm water and place over the closed eyelid for a few minutes, six times a day. (or place warm water in a thermos and make a compress every commercial while watching TV.) Do NOT use boiling water!
Eyelid scrubs for blepharitis can be purchased from the drug store or made with very dilute baby shampoo. Steroid ointment can sometimes help decrease the inflammation but should not be used for more than two weeks at a time. Steroid injection is an option for people who do not have dark skin. Occasionally the blocked oil gland orifice can be needled open.
For persistent, cosmetically distrubing chalazion, surgical drainage (incision and currettage) can be performed. Surgical drainage requires a calm and cooperative patient and is performed under local anesthetic (freezing needle injection) in adults. Until the freezing takes effect, patients may experience 40 seconds of pain during the injection. The procedure requires about 15 minutes and there will be bleeding from the eyelid. We usually evert the eyelid to drain the chalazion.
Small chalazia can sometimes be injected with steroid.
Chalazion surgery is rarely ever an emergency. If the patient cannot remain calm, still and cooperative, chalazion surgery should not be done. Dr. Ing can prescribe pain pill and anti-anxiety pills, and you can return another day after the pills have worked for several hours. (Don’t drive if you have taken a sedative.)
Chalazion surgery improves appearance more than function. About 10% of chalazia may recur in the same spot even after properly performed surgical drainage.
Sign the permission slip (consent) for surgery if you want the procedure done.
After chalazion surgery you will wear a patch for a half hour so that you will not make your clothes or car messy. Do NOT drive with an eye patch on. The patch may be red with blood when you remove it and the eyelid skin may be brown from antiseptic. Do not worry.
After the patch has been removed take a shower. Your vision may be blurry for a while after the patch has been removed because of the antibiotic ointment used after the procedure.
You may find spots of blood on the pillow or kleenex for a few days after the procedure. About 10% of chalazia will reaccumulate after your body heals over the incision site. Your eyelid lump may remain chronically pink. A blood clot may fall out days to weeks following the procedure.
If you get multiple chalazia, do NOT get every chalazion operated on to avoid excessive lid scarring. Pick your battles.
In patients with rosacea, chronic doxycycline pills can be prescribed by your family doctor or dermatologist. However the doxycycline side effects may be worse than the chalazia. If you take these pills you must avoid sunlight or else you will get a skin rash. Many people find it difficult to swallow the tetracycline pills. Doxycycline may adversely interact with medicines such as birth control pills or anticoagulants. Diarrhea and abdominal pain are common. Chronic doxy-cycline may cause liver problems. Children less than 8 years of age will get staining of their teeth.
Less substantiated treatments for chalazion include: 1) avoiding all cow’s milk products 2) Using soy milk and nuts 3) Using omega fish oil. 4) Tea tree oil for demodex blepharitis (e.g. Cliradex) Contact Labtician Ph: (905) 829.0055 5) Lipiflow: Contact Herzig Eye Institute) 6) ?Botox injections