Chalazion in Emergency Medicine Treatment & Management

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

Emergency Department Care

Conservative management of chalazia includes lid hygiene and warm compresses.[8, 9] More than 50% of chalazia resolve with conservative treatment.

  • For lid hygiene, patients can use drops of baby shampoo lathered on to and washed off of the affected eyelid.
  • Warm compresses should be applied for 15 minutes (4 times per day on an outpatient basis). This encourages resolution of the ductal blockage and aids in sebum drainage.
  • Shampoo to treat seborrhea can be used over the eyebrows to minimize possible ductal blockage from skin particles.
  • Topical or systemic antibiotics usually are not necessary because chalazia are secondary to sterile inflammation. Oral tetracyclines may aid in decreasing inflammation and minimizing secondary infection in the acute setting and may also prevent recurrence in the chronic setting. If patients are allergic to tetrcyclines, metronidazole may be used.

Steroid injections and surgical drainage should be deferred to an ophthalmologist or plastic surgeon; these procedures are not generally performed in the ED.[10] Injection and removal of chalazia may create cosmetic morbidity.[11]

  • If no evidence of infection is present, the chalazion can be injected with a steroid (eg, triamcinolone, methylprednisolone) as they can inflammation and frequently cause regression of the chalazion within a few weeks. 0.2-2 mL of 5 mg/mL triamcinolone can be injected directly into chalazion's center. A second injection may be necessary for larger chalazia. Complications of steroid injections include hypopigmentation, atrophy of the area, corneal perforation and traumatic cataract, and potential exacerbation of bacterial or viral infection.
  • Excision of chalazion generally is not performed in the ED but involves making a vertical incision in the palpebral conjunctival surface. For small chalazia, curettage of the inflammatory granuloma in the lid is performed. For larger chalazia, dissection of the granuloma may be needed for complete removal. The meibomian gland may also be cauterized or removed. For chalazia extending to the skin, a horizontal incision of the skin surface is used rather than through the conjunctiva to completely remove the inflammation. Involvement of the lid margins raises additional concern of disfigurement.
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Consultations

  • Refer patients for follow-up care with an ophthalmologist after 2 weeks if conservative management does not completely resolve the chalazion. Refer earlier for recurrent chalazia that have not been further evaluated.
  • Consider also referring some patients to dermatologists, as skin disorders predispose to chalazia.
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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

  1. Lederman C, Miller M. Hordeola and chalazia. Pediatr Rev. Aug 1999;20(8):283-4. [Medline].

  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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