Introduction
Background
A chalazion (Greek for hailstone) is a lipogranuloma of either a meibomian gland or a Zeis gland. When the former is involved, the lid nodule is characteristically hard and painless lid nodule; with the latter, it is marginal or superficial.
Pathophysiology
Lipid breakdown products, possibly from bacterial enzymes (as free fatty acids) or from retained sebaceous secretions, leak into the surrounding tissue and incite a granulomatous inflammatory response. The resulting mass of granulation tissue and chronic inflammation (with lymphocytes and lipid-laden macrophages) distinguishes a chalazion from an internal or external hordeolum, which is primarily an acute pyogenic inflammation with polymorphonuclear leucocytes and necrosis with pustule formation. However, one condition can result in the other because of their close proximity.
On clinical examination, the single, nontender, firm nodule (or, in rare cases, multiple nodules) is located deep within the lid or the tarsal plate, whereas a hordeolum is more superficial and is typically centered on an eyelash. Eversion of the lid may reveal the dilated meibomian gland and chronic inspissation of adjoining glands. With judicious pressure on the lid, the thick secretions can be seen extruding like toothpaste, resulting in tear debris.
Frequency
United States
Chalazia are common, but the exact incidence or prevalence is unknown.
International
No data about the prevalence or incidence are available.
Mortality/Morbidity
Acute inflammatory exacerbation can result in a rupture anteriorly (through the skin) or posteriorly (through the conjunctiva), forming a granuloma pyogenicum.
Race
No information about prevalence or incidence with respect to race is available.
Sex
- Male and females seem equally affected, but precise information about prevalence and incidence is not available.
- Contrary to popular opinion, research has not shown that the use of eyelid cosmetic products either causes or aggravates the condition.
Age
Chalazia occur in all age groups.
- Chalazia are more common in adults than in children, as androgenic hormones increase sebum viscosity.
- Although they are uncommon at extremes of age, pediatric cases may be encountered.
- Hormonal influences on sebaceous secretion and viscosity may explain clustering at the time of puberty and during pregnancy. However, the large number of patients without evidence of hormonal alteration suggests that other mechanisms also apply.
Clinical
History
Patients usually present with a short history of recent lid discomfort, followed by acute inflammation (eg, redness, tenderness, swelling). They frequently have a long history of previous similar occurrences, because chalazia tend to recur in predisposed individuals.
Physical
Chalazia are more common on the upper lid than on the lower lid because of the increased number and length of meibomian glands present on the upper lid.
Chronic inspissation of the meibomian secretions may be apparent as meibomian gland dysfunction. This condition is characterized by pressure on the eyelids that produces copious toothpaste-like secretions instead of the normal small amount of clear, oily secretion. Sebaceous dysfunction and obstruction elsewhere (eg, comedones, oily face) are the only associated features or specific general findings.
Rosacea is a frequent associated finding. When present, rosacea demonstrates very specific findings, such as facial erythema; telangiectatic and spider nevi on the malar, nasal, and lid skin; and rhinophyma.
Causes
Chalazia may arise spontaneously due to blockage of a gland orifice or due to an internal hordeolum. Chalazia are associated with seborrhea, chronic blepharitis, and acne rosacea.
Poor lid hygiene is occasionally associated with chalazia, although its causal role needs to be established. Although stress is often apparently associated with chalazia, it has not been proven as a cause, and the mechanism by which stress acts is unknown.
More on Chalazion |
 Overview: Chalazion |
| Differential Diagnoses & Workup: Chalazion |
| Treatment & Medication: Chalazion |
| Follow-up: Chalazion |
| References |
| Next Page » |
References
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. May 2005;112(5):913-7. [Medline].
Gershen HJ. Chalazion. In: Master Techniques in Ophthalmic Surgery. Baltimore: Williams and Wilkins; 1995:370-3.
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].
Further Reading
Keywords
chalazia, hailstone, lipogranuloma, meibomian gland, Zeis gland, seborrhea, chronic blepharitis, acne rosacea, lid nodule, interior (posterior) hordeolum
