eMedicine Specialties > Emergency Medicine > Ophthalmology

Chalazion: Treatment & Medication

Author: Jane Lee Fansler, MD, Resident Physician, Stanford University/Kaiser Permanente Emergency Medicine Residency Program
Coauthor(s): Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center; Sally Santen, MD, Program Director, Assistant Professor, Department of Emergency Medicine, Vanderbilt University
Contributor Information and Disclosures

Updated: Apr 22, 2009

Treatment

Emergency Department Care

Conservative management of chalazia includes lid hygiene and warm compresses.7 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.8 Injection and removal of chalazia may create cosmetic morbidity.9

  • 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.

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.

Medication

Since chalazia are sterile inflammations, topical antibiotics usually do not assist in treatment. Chronic oral tetracycline, doxycycline, or metronidazole (Flagyl) may be useful in the setting of chronic, recurrent chalazia. These medications should be prescribed only after evaluation by an ophthalmologist.

Anti-inflammatory Agent

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.


Triamcinolone (Amcort)

For inflammatory dermatosis responsive to steroids; decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability.

Adult

0.1-0.2 mL of 40 mg/mL injected directly into chalazion's center; second injection may be necessary after a few weeks for larger chalazia

Pediatric

Not established

Documented hypersensitivity; fungal, viral, and bacterial skin infections

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

A percentage of topical drug might be absorbed systemically; if application repeated, may experience some systemic effects of corticosteroids; certain skin types may develop loss of eyelid pigmentation after injection; may also experience atrophy of subcutaneous tissues, and risk of developing glaucoma

More on Chalazion

Overview: Chalazion
Differential Diagnoses & Workup: Chalazion
Treatment & Medication: Chalazion
Follow-up: Chalazion
Multimedia: Chalazion
References
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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. 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].

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

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

  6. 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].

  7. 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].

  8. 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].

  9. 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].

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  12. 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].

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Further Reading

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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, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
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.

Medical Editor

David FM Brown, MD, Assistant Professor, Department of Medicine, Division of Emergency Medicine, Harvard Medical School; Associate-Chief, Attending Physician, 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: Schering  Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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.

CME Editor

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, Emergency Medicine, University Hospitals, Case Medical Center
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.

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