Chalazion Clinical Presentation
- Author: Jean Deschênes, MD, FRCSC; Chief Editor: Hampton Roy, Sr, MD more...
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.
The following should be documented:
Any changes in visual acuity
Any recent viral infections
Any history of frequent skin infections
Any exposure to or history of tuberculosis 
Any personal history of cancer 
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.
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.
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).
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.
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.
Lederman C, Miller M. Hordeola and chalazia. Pediatr Rev. 1999 Aug. 20(8):283-4. [Medline].
Litoff D, Balin MW. Ocular infections and inflammation. Catalano RA, ed. Ocular Emergencies. WB Saunders; 1992. 468-471.
Sethuraman U, Kamat D. The red eye: evaluation and management. Clin Pediatr (Phila). 2009 Jul. 48(6):588-600. [Medline].
Santa Cruz CS, Culotta T, Cohen EJ, Rapuano CJ. Chalazion-induced hyperopia as a cause of decreased vision. Ophthalmic Surg Lasers. 1997 Aug. 28(8):683-4. [Medline].
Berman JD. Human leishmaniasis: clinical, diagnostic, and chemotherapeutic developments in the last 10 years. Clin Infect Dis. 1997 Apr. 24(4):684-703. [Medline].
Aoki M, Kawana S. Bilateral chalazia of the lower eyelids associated with pulmonary tuberculosis. Acta Derm Venereol. 2002. 82(5):386-7. [Medline].
Khan JA, Doane JF, Grove AS Jr. Sebaceous and meibomian carcinomas of the eyelid. Recognition, diagnosis, and management. Ophthal Plast Reconstr Surg. 1991. 7(1):61-6. [Medline].
Goawalla A, Lee V. A prospective randomized treatment study comparing three treatment options for chalazia: triamcinolone acetonide injections, incision and curettage and treatment with hot compresses. Clin Experiment Ophthalmol. 2007 Nov. 35(8):706-12. [Medline].
Sharma R, Brunette DD. Ophthalmology. In: Marx, ed. Rosen’s Emergency Medicine. Vol 2. 7th ed. 2009:Chap 69.
Ho SY, Lai JS. Subcutaneous steroid injection as treatment for chalazion: prospective case series. Hong Kong Med J. 2002 Feb. 8(1):18-20. [Medline].
Hosal BM, Zilelioglu G. Ocular complication of intralesional corticosteroid injection of a chalazion. Eur J Ophthalmol. 2003 Nov-Dec. 13(9-10):798-9. [Medline].
Gilchrist H, Lee G. Management of chalazia in general practice. Aust Fam Physician. 2009 May. 38(5):311-4. [Medline].
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].
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].
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].