Introduction
Background
Focal swelling of the eyelid is a common complaint that is seen in the primary care or urgent care setting. Often, the swelling can be identified as either a hordeolum (stye) or a chalazion, although several other benign and malignant processes can be mistaken for these two.1
Chalazion with the lid inverted. Photo by Larry Stack, MD.
Chalazion. Photo by Larry Stack, MD.
Chalazia are the most common inflammatory lesions of the eyelid. A chalazion is a slowly enlarging nodule on the eyelid that is formed by inflammation and obstruction of a sebaceous gland. Chalazia can further be categorized into superficial or deep, depending on which glands are blocked. Inflammation of the meibomian glands leads to deep chalazia, whereas inflammation of Zeis sebaceous glands leads to superficial chalazia. Chalazia can reoccur, and those that do should be evaluated for malignancy.
It is difficult to state definitively the origin of the word chalazion (pleural: chalazia). Reported origins include Greek words meaning "small lump," "hailstone," or "pimple."
For related information, see Medscape's Ophthalmology Resource Center.
Pathophysiology
A chalazion forms when the meibomian gland becomes blocked and sebaceous secretions accumulate. Reaction to the material results in granulation tissue and chronic inflammation.2
The large meibomian glands are embedded in the tarsal plate of the eyelid; therefore, edema usually is contained on the conjunctival portion of the lid. Occasionally, the chalazion enlarges and breaks through the tarsal plate to the external portion of the eyelid. Blockage of the Zeis glands may cause chalazia to occur along the lid margin.
Chalazia are different from hordeolums in that they form as a result of gland obstruction and sterile inflammation as opposed to a purulent infection of the cilium. Chalazia tend to be larger, less painful, and occur less acutely than hordeolums.
Following the acute inflammation of a hordeolum, a chalazion may occur, in which case, the lesion becomes less painful and eventually painless.
Frequency
United States
Exact incidence or prevalence of chalazia in the United States is not known; however, chalazia are common. Acne rosacea, seborrheic dermatitis, and chronic blepharitis are some predisposing skin and eyelid conditions. Chalazia are more commonly found on the upper eyelid.
International
No known difference exists in international prevalence.
Mortality/Morbidity
- Persistent drainage and swelling can cause irritation to the eye.
- Disease progression of a chalazion can lead to a disfiguration of the eyelids. Continued inflammation could also lead to a pyogenic granuloma.
- Chalazia can predispose to preseptal cellulitis, especially in those with atopy.
- Large, centrally located chalazion can cause visual disturbances by pressing on the cornea causing mechanical with-the-rule astigmatism. Acquired hyperopia and decreased vision have been caused by a chalazion of the upper eyelid.3
- Most morbidity is secondary to infection caused by improper drainage. An ophthalmologist or one familiar with eyelid anatomy and necessary surgical techniques would best perform proper surgical management.
Race
No racial predilection is thought to exist.
Sex
Males and females seem to be equally affected.
Age
Chalazia are more common in adults than in children. This is thought to be related to hormonal changes in sebum. The risk of developing chalazia increases in those aged 30-50 years.
- Recurrent chalazion, particularly in the elderly patient, should prompt the practitioner to consider conditions masquerading as a chalazion such as sebaceous carcinoma, squamous cell carcinoma, microcystic adnexal carcinoma, or tuberculosis.
- Children or young adults with recurrent chalazion should prompt the practitioner to examine the patient for viral conjunctivitis and hyperimmunoglobulinemia E (hyper-IgE) syndrome (Job syndrome).
Clinical
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.4
- Document recent viral infections.
- Document immune competency status. Ask if the patient has frequent skin infections.
- Ask about exposure or history of tuberculosis (TB).5
- Ask about personal history of cancer.6
- 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.
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.
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
More on Chalazion |
 Overview: Chalazion |
| Differential Diagnoses & Workup: Chalazion |
| Treatment & Medication: Chalazion |
| Follow-up: Chalazion |
| Multimedia: Chalazion |
| References |
| Next Page » |
References
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Further Reading
Keywords
chalazion, chalazia, nodule on eyelid, meibomian glands, deep chalazion, Zeis sebaceous glands, superficial chalazion, painless granuloma on eyelid, painless swelling on eyelid, seborrhea, acne rosacea, chronic blepharitis, high blood lipid concentrations, meibomian cyst, meibomian gland lipogranuloma, tarsal cyst
