Follow-up
Further Outpatient Care
- Routine follow-up at approximately 1 month should reveal resolution of the problem, with no swelling, redness, or persistent lump. Any persistence of a nodule suggests the diagnosis included not simply a chalazion but also sebaceous cell carcinoma or other lid lesion.
- For further evaluation and management, appropriate specimens of tissue should be obtained for histologic evaluation.
- Because sebaceous cell carcinoma is best evaluated by using lipid stains, alert the pathologist to perform tissue processing without dehydration (ie, frozen section).
- The specimen should still be prepared in formalin to avoid autolysis; it is not the formalin that removes the lipid, but rather, the alcohol baths used in paraffin sectioning.
Transfer
- Urgent transfer to an experienced orbital and/or ophthalmic plastic surgeon is mandatory after biopsy results are documented or if the clinical findings suggest sebaceous cell carcinoma.
Deterrence/Prevention
- Prophylaxis involves frequent regular massage of the eyelids. Massage, heat, and moisture are critical to help empty the glands.
- Instruct the patient about the "4 fingers times 10" routine, as follows:
- At the end of a bath or shower, work up a lather on clean hands by using warm water and a drop of baby shampoo. (Baby shampoo does not sting if it gets into the eye.)
- Close both eyes, and cover the lashes and both the upper and lower eyelids by using the index finger.
- Vigorously massage the eye by making horizontal to-and-fro movements. Count each movement until 10 movements have been completed; this is the "10" part of the "4 fingers times 10" routine.
- Repeat the entire procedure by using the middle finger, then the ring finger, then the little finger; this is the "4 fingers" part of the "4 fingers times 10" routine.
- Rinse off the remaining shampoo.
- The use of topical mild steroid and/or antibiotic drops may help suppress the granulomatous inflammation.
- An alternate method is to use a warm, moist compress. This simple method has the advantage of being effective and easy to perform.
- Using a clean face towel, shape the middle section so it looks like a finger, and place it under running warm water.
- After this "finger" of the towel has cooled off, use it to gently massage the upper and lower eyelids in a horizontal motion to open up any blocked meibomian glands.
Complications
- Improperly drained marginal chalazia can result in notching, trichiasis, and loss of lashes.
- Biopsy is required to rule out malignancy in cases of recurrent chalazia or those appearing atypical.
- Alert the pathologist of suspected sebaceous cell carcinoma and request frozen sections and lipid stains.
- Astigmatism may result when the lid mass distorts the corneal contour.
- Partially drained chalazia can result in large masses of granulation tissue prolapsing onto the conjunctiva or skin.
Prognosis
- Patients receiving therapy usually have an excellent outcome.
- New lesions often occur, and inadequate drainage may result in a local recurrence.
- Untreated chalazia occasionally drain spontaneously, but they are more likely than treated chalazia to persist with intermittent acute inflammation.
Patient Education
- Instruct patients about the importance of adequate lid hygiene and general health measures (eg, rest, stress management, proper diet) in maintaining good skin function. Explain that the lesions are benign, but meticulous lid hygiene and dedication may be required as preventive measures.
- The following points (in decreasing order of importance) are important:
- Gentle but firm and vigorous massage to promote drainage of the meibomian glands
- Warmth to help melt the viscous lipids
- Water to remove the secretions collecting on the lid margin
- Use of baby shampoo, which does not sting if it gets into the eye
- More complex procedures may be preferred.
- An example is the use of diluted baby shampoo on a cotton wool applicator to rub along the mucocutaneous junction and gray line of the lid.
- However, methods such as this one do not promote adequate drainage of the glandular secretions; they are also cumbersome and difficult, and additional paraphernalia are required.
- For excellent patient education resources, visit eMedicine's Eye and Vision Center. Also, see eMedicine's patient education articles Chalazion (Lump in Eyelid) and Sty.
Miscellaneous
Medicolegal Pitfalls
- Recurrent chalazia, especially if they recur despite previous successful drainage in the same location, must be considered malignant sebaceous cell carcinoma. Prompt biopsy with frozen-section histologic study is warranted.
- Poorly executed incisions (eg, those transgressing the edge of the lid) result in notching. Incisions that are too deep may result in cutaneous fistulae and scars.
- Intralesional corticosteroid injections may result in cosmetically unacceptable loss of skin pigmentation or inadvertent injections into the globe. In predisposed individuals, the corticosteroid may result in an elevation of intraocular pressure.
- Inadequate curettage and drainage may result in recurrences or the development of granulomata.
Special Concerns
- Occasionally, patients present with profound concern for the causal factors for lid inflammation, including chalazia. These individuals may have major anxiety because of misinformation that Demodex folliculorum may have caused severe infestation, resulting in the lid disease.
- No evidence suggests that Demodex species cause lid disease; this ubiquitous parasite appears to be a harmless commensal organism, but it has been implicated in mange in dogs.
- Treatment of demodicosis includes the application of ointment at night to the eyes, a practice that results in the parasite being smothered.
More on Chalazion |
| Overview: Chalazion |
| Differential Diagnoses & Workup: Chalazion |
| Treatment & Medication: Chalazion |
 Follow-up: Chalazion |
| References |
| « Previous Page |
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References
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Mansour AM, Chan CC, Crawford MA, Tabbarah ZA, Shen D, Haddad WF, et al. Virus-induced chalazion. Eye. Feb 2006;20(2):242-6. [Medline].
Ozdal PC, Codere F, Callejo S, Caissie AL, Burnier MN. Accuracy of the clinical diagnosis of chalazion. Eye. Feb 2004;18(2):135-8. [Medline].
Rosas Vasquez E, Campos Maocias P, Ocha Tirado JG. Chloracne in the 1990s. Int J Dermatol. 1966;35:643-645.
Shiramizu KM, Kreiger AE, McCannel CA. Severe visual loss caused by ocular perforation during chalazion removal. Am J Ophthalmol. Jan 2004;137(1):204-5. [Medline].
Soil DB, Wisnlow R. Surgery of the eyelids. In: Tasman W, Jaeger EA, eds. Duane's Foundations of Clinical Ophthalmology. Vol 5. JBL; 1999:56-9.
Wessels IF. Chalazion. In: Fraunfelder FT, Roy FH, eds. Current Ocular Therapy. Philadelphia: W. B. Saunders; 2000:423-5.
Wessels IF, Wessels GF. Lidocaine-prilocaine cream for local-anesthesia chalazion incision in children. Ophthalmic Surg Lasers. Jun 1996;27(6):431-3. [Medline].
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Further Reading
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Keywords
chalazia, hailstone, lipogranuloma, meibomian gland, Zeis gland, seborrhea, chronic blepharitis, acne rosacea, lid nodule, interior (posterior) hordeolum
