Medication Summary
Medical therapy for a chalazion is rarely indicated, except in cases of rosacea, for which a 6-month course of low-dose tetracycline may be of benefit. Doxycycline in dosages as low as 100 mg/week for 6 months may result in permanent biochemical change, with the sebaceous glands producing shorter-chain fatty acids, which are less likely to congeal and block gland orifices than longer-chain fatty acids are.
Although probably innocuous, topical antibiotics do not help this condition, which is not infectious. If there is a question regarding the possibility of infection within the lump, topical erythromycin ointment may be used after each application of hot compresses. Systemic tetracycline may be beneficial, but local drops are unlikely to help and are more likely to cause a contact dermatitis-type reaction. Long-term oral tetracycline, doxycycline, or metronidazole may be useful in the setting of chronic, recurrent chalazia.
Topical steroids can be helpful in minimizing inflammation and in reducing edema, thereby facilitating any drainage that may take place.
Antibiotics
Class Summary
Antibiotics are not indicated as treatment for an inflammatory lesion without evidence of an active infection. Significant benefit may be derived from low-dose, long-term oral therapy with tetracycline derivatives.
Tetracycline
The useful effects of tetracycline class antibiotics in patients with chalazia include altering the skin bacterial flora and altering lipids to produce shorter-chain fatty acids, thereby lowering the melting point and viscosity of sebaceous secretions and possibly preventing blockage of meibomian glands. Additional mechanisms of action may also benefit patients with acute and chronic chalazion, and long-term maintenance therapy may prevent recurrences.
Doxycycline (Doryx, Vibramycin, Adoxa, Doxy 100)
Doxycycline inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. It alters lipids to produce shorter-chain fatty acids, thereby lowering the melting point of sebaceous secretions and possibly preventing blockage of meibomian glands.
Minocycline (Minocin, Solodyn)
Minocycline alters lipids to produce shorter-chain fatty acids, lowering the melting point of sebaceous secretions and possibly preventing meibomian gland blockage.
Metronidazole (Flagyl, Metro)
When taken orally, metronidazole may benefit patients who are unable to take tetracyclines.
Bacitracin
Bacitracin prevents transfer of mucopeptides into the growing cell wall, which causes inhibition of bacterial cell wall synthesis.
Polymyxin B/bacitracin topical (Double Antibiotic, Polysporin)
Bacitracin prevents transfer of mucopeptides into the growing cell wall, which causes inhibition of bacterial cell wall synthesis. Polymyxin B damages bacterial cytoplasmic membrane and alters permeability, causing intracellular constituents to leak. Used to treat open excoriations and erosions.
Corticosteroids
Class Summary
Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the immune response of the body to diverse stimuli. Cicatricial complications may be avoided with judicious use of topical or injected corticosteroids.
Triamcinolone (Aristospan Intra-Articular, Kenalog)
The advantages of triamcinolone over other depot corticosteroids are decreased discomfort and reduced cost. Triamcinolone is used for inflammatory dermatoses responsive to steroids. This agent decreases inflammation by suppressing migration of PMNs and reversing capillary permeability. It acts to minimize scarring and inflammation. Injection of depo-steroids into the lid may raise intraocular pressure (steroid glaucoma) in susceptible individuals (steroid responders).
Methylprednisolone (DepoMedrol, Medrol, Solu-Medrol, A-Methapred)
Methylprednisolone decreases inflammation by suppressing migration of PMNs and reducing capillary permeability.
Dexamethasone (Baycadron, Dexamethasone Intensol)
Dexamethasone is used for various inflammatory diseases. It decreases inflammation by suppressing migration of PMNs and reducing capillary permeability.
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Chalazion. Image courtesy of Larry Stack, MD
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Chalazion with eyelid everted. Image courtesy of Larry Stack, MD.
