Chalazion in Emergency Medicine Clinical Presentation

  • Author: Jane Lee Fansler, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: May 15, 2012
 

History

A chalazion is usually a painless swelling on the eyelid that has been present for weeks to months. Patients may seek medical attention when a chalazion causes impaired vision, double vision, discomfort, or pain or becomes inflamed and painful, or infected.

  • The chief complaint must be examined in a thorough manner including questions concerning location, onset, duration, intensity, exacerbating and mitigating factors, previous intervention, and evaluation. If the chalazion is recurrent, inquire how often this has occurred before and if it is in the same location.
  • Changes in visual acuity must be clearly documented.
  • As the world becomes flatter, and intercontinental travel becomes easier, querying the patient about a travel history, particularly to locations known to be sources of leishmaniasis, is important.[5]
  • Document recent viral infections.
  • Document immune competency status. Ask if the patient has frequent skin infections.
  • Ask about exposure or history of tuberculosis (TB).[6]
  • Ask about personal history of cancer.[7]
  • Symptoms such as eye pain, acute visual changes, fevers, limitation of extraocular movement, and diffuse eyelid swelling point to a diagnosis other than a chalazion.
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Physical

Completely examine the eye and conjunctival surface.

  • A chalazion is a palpable nodule on the eyelid.
  • Chalazia usually are nontender, nonerythematous, and nonfluctuant. Large chalazia may be tender secondary to size effects.
  • Invert the eyelid to visualize the palpebral conjunctiva and identify internal chalazia.
  • Chalazia may grow to 7-8 mm in diameter.
  • Injection of the conjunctiva is a common secondary finding.
  • Examine preauricular nodes to help determine infection.
  • No intraocular pathology should be found.
  • Presence of fever or distant nodes is not consistent with a chalazion.
  • Also note other skin findings including acne, seborrhea, rosacea, and atopy.
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Causes

Chalazia occur after gland blockage, which can be associated with the following:

  • Poor lid hygiene
  • Seborrhea
  • Acne rosacea
  • Chronic blepharitis
  • High blood lipid concentrations (possible risk from increased blockage of sebaceous glands)
  • Leishmaniasis
  • TB
  • Immunodeficiency
  • Viral infection
  • Carcinoma
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Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Jane Lee Fansler, MD  Resident Physician, Stanford University/Kaiser Permanente Emergency Medicine Residency Program

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

Disclosure: Nothing to disclose.

Coauthor(s)

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

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.

Specialty Editor Board

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: 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

Douglas Lavenburg, MD  Clinical Professor, Department of Emergency Medicine, Christiana Care Health Systems

Douglas Lavenburg, MD is a member of the following medical societies: American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

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.

References

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  2. Litoff D, Balin MW. Ocular infections and inflammation. In: Catalano RA, ed. Ocular Emergencies. WB Saunders; 1992:468-471.

  3. Sethuraman U, Kamat D. The red eye: evaluation and management. Clin Pediatr (Phila). Jul 2009;48(6):588-600. [Medline].

  4. Santa Cruz CS, Culotta T, Cohen EJ, et al. Chalazion-induced hyperopia as a cause of decreased vision. Ophthalmic Surg Lasers. Aug 1997;28(8):683-4. [Medline].

  5. Berman JD. Human leishmaniasis: clinical, diagnostic, and chemotherapeutic developments in the last 10 years. Clin Infect Dis. Apr 1997;24(4):684-703. [Medline].

  6. Aoki M, Kawana S. Bilateral chalazia of the lower eyelids associated with pulmonary tuberculosis. Acta Derm Venereol. 2002;82(5):386-7. [Medline].

  7. 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].

  8. 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. Nov 2007;35(8):706-12. [Medline].

  9. Sharma R, Brunette DD. Ophthalmology. In: Marx, ed. Rosen's Emergency Medicine. Vol 2. 7th ed. 2009:Chap 69.

  10. Ho SY, Lai JS. Subcutaneous steroid injection as treatment for chalazion: prospective case series. Hong Kong Med J. Feb 2002;8(1):18-20. [Medline].

  11. Hosal BM, Zilelioglu G. Ocular complication of intralesional corticosteroid injection of a chalazion. Eur J Ophthalmol. Nov-Dec 2003;13(9-10):798-9. [Medline].

  12. Arbabi EM, Kelly RJ, Carrim ZI. Chalazion. BMJ. Aug 10 2010;341:c4044. [Medline]. [Full Text].

  13. Brookes JL, Bentley C, Verma S, et al. Microcystic adnexal carcinoma masquerading as a chalazion. Br J Ophthalmol. Feb 1998;82(2):196-7. [Medline].

  14. Crama N, Toolens AM, van der Meer JW, et al. Giant chalazia in the hyperimmunoglobulinemia E (hyper-IgE) syndrome. Eur J Ophthalmol. May-Jun 2004;14(3):258-60. [Medline].

  15. De Silva DJ, Tumuluri K, Joshi N. Conjunctival squamous cell carcinoma: atypical presentation of HIV. Clin Experiment Ophthalmol. Aug 2005;33(4):419-20. [Medline].

  16. Destafeno JJ, Kodsi SR, Primack JD. Recurrent Staphylococcus aureus chalazia in hyperimmunoglobulinemia E (Job's) syndrome. Am J Ophthalmol. Dec 2004;138(6):1057-8. [Medline].

  17. Gershen HJ. Chalazion. In: Fraunfelder FT, et al, eds. Current Ocular Therapy, 4. WB Saunders; 1995:563-564.

  18. Koo L, Hatton MP, Rubin PA. "Pseudo-pseudochalazion": giant chalazion mimicking eyelid neoplasm. Ophthal Plast Reconstr Surg. Sep 2005;21(5):391-2. [Medline].

  19. Mansour AM, Chan CC, Crawford MA, et al. Virus-induced chalazion. Eye. Feb 2006;20(2):242-6. [Medline].

  20. Mueller JB, McStay CM. Ocular infection and inflammation. Emerg Med Clin North Am. Feb 2008;26(1):57-72, vi. [Medline].

  21. Mustafa TA, Oriafage IH. Three methods of treatment of chalazia in children. Saudi Med J. Nov 2001;22(11):968-72. [Medline].

  22. Ozdal PC, Codere F, Callejo S, et al. Accuracy of the clinical diagnosis of chalazion. Eye. Feb 2004;18(2):135-8. [Medline].

  23. Palva J, Pohjanpelto PE. Intralesional corticosteroid injection for the treatment of chalazia. Acta Ophthalmol (Copenh). Oct 1983;61(5):933-7. [Medline].

  24. Shields JA, Demirci H, Marr BP, et al. Sebaceous carcinoma of the eyelids: personal experience with 60 cases. Ophthalmology. Dec 2004;111(12):2151-7. [Medline].

  25. Smythe D, Hurwitz JJ, Tayfour F. The management of chalazion: a survey of Ontario ophthalmologists. Can J Ophthalmol. Aug 1990;25(5):252-5. [Medline].

 
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Chalazion. Photo by Larry Stack, MD.
Chalazion with the lid inverted. Photo by Larry Stack, MD.
 
 
 
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