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Chalazion Clinical Presentation

  • Author: Jean Deschênes, MD, FRCSC; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Dec 02, 2015
 

History

A chalazion is usually a painless swelling on the eyelid that has been present for weeks to months. Patients may seek medical attention only when the condition worsens, as when a chalazion causes impaired vision or discomfort or becomes inflamed, painful, or infected. Frequently, there is a long history of previous similar occurrences because chalazia tend to recur in predisposed individuals.

The chief complaint must be examined thoroughly, including questions regarding the location of the lesion, its onset, duration, intensity, and exacerbating and mitigating factors, as well as previous interventions and evaluations. If the chalazion is recurrent, the patient should be asked how often it has occurred before and if the new lesion is in the same location as a previous one.

As intercontinental travel becomes easier, it is increasingly important to inquire into the patient’s history of travel, particularly to regions known to be endemic for tuberculosis and leishmaniasis.[5]

The following should be documented:

  • Any changes in visual acuity
  • Any recent viral infections
  • Immunocompetence
  • Any history of frequent skin infections
  • Any exposure to or history of tuberculosis [6]
  • Any personal history of cancer [7]

Symptoms such as eye pain, acute visual changes, fever, limitation of extraocular movement, and diffuse eyelid swelling point to a diagnosis other than a chalazion.

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Physical Examination

A complete examination of the eye and of the conjunctival surface should be carried out. A chalazion takes the form of a palpable nodule on the eyelid, sometimes as large as 7-8 mm in diameter. Usually, it is firm, nonerythematous, nonfluctuant, and nontender, although a large or acute chalazion may be tender as a consequence of size effects. Chalazia are more common on the upper lid (see the image below) than on the lower lid because of the increased number and length of meibomian glands present in the upper lid.

Chalazion. Image courtesy of Larry Stack, MD Chalazion. Image courtesy of Larry Stack, MD

Physical features help distinguish a chalazion from a hordeolum. Patients with the former generally have a single firm nontender nodule (or, in rare cases, multiple nodules) located deep within the lid or the tarsal plate, whereas patients with the latter have a more superficial and painful lesion that is typically centered on an eyelash.

The eyelid should be everted to allow visualization of the palpebral conjunctiva and to identify an internal chalazion (see the image below).

Chalazion with eyelid everted. Image courtesy of L Chalazion with eyelid everted. Image courtesy of Larry Stack, MD.

Eversion of the lid may reveal a dilated meibomian gland and chronic inspissation of adjoining glands. A gentle compression of these glands produces copious toothpastelike secretions instead of the normal small amount of clear oily secretions.

The following should be kept in mind during the physical examination:

  • Injection of the palpebral conjunctiva is a common secondary finding
  • Preauricular nodes should be examined to help determine whether infection is present
  • No intraocular pathology should be found
  • The presence of fever or distant nodes is not consistent with a chalazion

Other skin findings (eg, acne, seborrhea, rosacea, atopy) should be noted. Rosacea is a finding frequently associated with a chalazion. When present, rosacea demonstrates specific characteristics, such as facial erythema; telangiectatic and spider nevi on the malar, nasal, and lid skin; and rhinophyma.

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Complications

Potential complications of chalazia include cosmetic deformity and infection, including the development of hordeolum or preseptal cellulitis.

Improperly drained marginal chalazia can result in notching, trichiasis, and loss of lashes. Partially drained chalazia can result in large masses of granulation tissue prolapsing through the conjunctiva or skin.

Visual disturbances can occur with large chalazia, and astigmatism may arise when the lid mass distorts the corneal contour.

Recurrences of chalazia are not uncommon. However, the physician should entertain the possibility of malignancy in such cases and should biopsy a lesion that recurs or appears atypical. The pathologist should be alerted to the suspicion of sebaceous cell carcinoma and frozen sections and lipid stains should be requested.

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Contributor Information and Disclosures
Author

Jean Deschênes, MD, FRCSC Professor, Research Associate, Director, Uveitis Program, Department of Ophthalmology, McGill University Faculty of Medicine; Senior Ophthalmologist, Clinical Director, Department of Ophthalmology, Royal Victoria Hospital, Canada

Jean Deschênes, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, Canadian Medical Association, Canadian Ophthalmological Society, Quebec Medical Association, International Ocular Inflammation Society

Disclosure: Nothing to disclose.

Coauthor(s)

Jane Lee Fansler, MD, FACEP Assistant System Medical Officer, Clayton Emergency Group

Jane Lee Fansler, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Phi Beta Kappa

Disclosure: Nothing to disclose.

Alexandre Plouznikoff, MD, PhD MASc, BEng, Resident Physician, Department of Ophthalmology, McGill University Faculty of Medicine, Canada

Alexandre Plouznikoff, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgements

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences,and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

David FM Brown, MD Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: lippincott Royalty textbook royalty; wiley Royalty textbook royalty

Jorge G Camara, MD Professor of Ophthalmology, Department of Surgery and Director of Fellowship Training Program in Ophthalmic Plastic and Reconstructive Surgery for Countries Served by the Aloha Medical Mission, University of Hawaii John A Burns School of Medicine

Jorge G Camara, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and American Society of Ophthalmic Plastic and Reconstructive Surgery

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Sally Santen, MD Program Director, Assistant Professor, Department of Emergency Medicine, Vanderbilt University

Sally Santen, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References
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  12. Gilchrist H, Lee G. Management of chalazia in general practice. Aust Fam Physician. 2009 May. 38(5):311-4. [Medline].

  13. Ben Simon GJ, Huang L, Nakra T, Schwarcz RM, McCann JD, Goldberg RA. Intralesional triamcinolone acetonide injection for primary and recurrent chalazia: is it really effective?. Ophthalmology. 2005 May. 112(5):913-7. [Medline].

  14. Ben Simon GJ, Rosen N, Rosner M, Spierer A. Intralesional triamcinolone acetonide injection versus incision and curettage for primary chalazia: a prospective, randomized study. Am J Ophthalmol. 2011 Apr. 151(4):714-718.e1. [Medline].

  15. Wong MY, Yau GS, Lee JW, Yuen CY. Intralesional triamcinolone acetonide injection for the treatment of primary chalazions. Int Ophthalmol. 2014 Oct. 34(5):1049-53. [Medline].

 
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Chalazion. Image courtesy of Larry Stack, MD
Chalazion with eyelid everted. Image courtesy of Larry Stack, MD.
 
 
 
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