Chalazion – Causes, treatment, surgery
A chalazion is an inflammatory cyst of the eyelid. It is not an infection, but an inflammation affecting one or more meibomian glands. It is completely benign, often quite alarming, and extremely unpleasant! You wake up with discomfort on one eyelid, the sensation of a very specific painful spot, which sometimes itches, and swelling that can affect the entire eyelid, which becomes very red and sensitive. In some cases, it is a small, well-defined lump that grows in the eyelid and persists for several weeks or months. This is not a stye , but a chalazion. It requires appropriate treatment with eyelid care and an anti-inflammatory ointment. If it persists for more than 4 to 6 weeks, it can be lanced. Never in an emergency, never without proper care!
What is a chalazion?
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This is a cyst that develops at the expense of the Meibomian glands, contained within the thickness of the eyelids.
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These glands, naturally present in the 4 eyelids, produce an oily substance (meibum) which is part of the composition of tears: meibum serves to lubricate the surface of the eye, limiting the evaporation of tears, which allows for good ocular hydration.
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In the event of dysfunction of these glands, the meibum remains trapped inside where it accumulates, which leads to the formation of a cyst, which can take on an inflammatory appearance (red, swollen and sensitive eyelid), or a chronic appearance (small persistent painless lump in the eyelid): this is the chalazion.
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A chalazion should not be confused with a stye, which is generally smaller, and is an infection of the eyelash root taking the form of a red and painful lump on the edge of the eyelid, topped with a white dot centered by an eyelash.
The causes
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The exact origin of the chalazion is not clearly established, but its occurrence is associated with the existence of chronic blepharitis (inflammation of the inner surface of the eyelids).
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Blepharitis is common in patients with benign skin conditions, such as acne, rosacea, seborrheic dermatitis, or atopic dermatitis.
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This chronic inflammatory condition causes a dysfunction of the Meibomian glands, leading to the formation of cysts.
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Several observations show that uncorrected vision problems, particularly hyperopia in young children, are often associated with the presence of recurrent chalazia.
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Correcting these disorders reduces the frequency of chalazia occurrence, although this cannot be formally explained from a pathophysiological point of view.
Why consult a doctor?
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Chalazion most often occurs in an inflammatory form, with a picture of a red, swollen and sensitive eyelid.
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At this stage, treatment is medical and requires a prescription for anti-inflammatory ointment issued by your ophthalmologist.
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The evolution most often leads to the disappearance of the inflammation and the collapse of the cyst, over a variable period of 6 days to 6 weeks, unlike a stye which has a brief evolution, generally less than a week.
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In some cases, the chalazion becomes chronic and the eyelid cyst is no longer painful, but takes on the appearance of a persistent or even recurring lump in the same place, thus requiring surgery.
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In rare cases, the chalazion can become infected and give rise to a picture of eyelid cellulitis, which requires systemic antibiotic treatment.
Course of action
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In the inflammatory phase (red, swollen and sensitive eyelid) – Consult urgently to begin treatment, which reduces the duration of the inflammation.
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During the infected phase – Consult a doctor to start antibiotic treatment to limit the development and progression.
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In the encysted phase – Consult to assess the benefit of a surgical incision under local anesthesia.
Evolution
The chalazion develops (too) slowly. The eyelid may take anywhere from a few hours to a few days to swell, but once formed, the cyst will likely take several weeks to disappear! For the first few days, medical treatment is disappointing. No improvement is noticeable for the first three days. After five to seven days, the eyelid becomes less inflamed. Then the cyst disappears in about two to three weeks.
Natural treatments and medications
The treatment of a chalazion in the inflammatory phase is primarily natural. This is referred to as mechanical treatment.
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Warm the affected eyelid for 2 to 3 minutes using a warm cotton ball, a damp washcloth, or a heating mask.
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Once the chalazion has warmed up, gently massage the eyelid for 2 minutes. Meibum (a white, pus-like fluid) may come out of the eyelid. Rinse it off with saline solution.
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After the massage, apply the prescribed anti-inflammatory cream (such as Sterdex®) to the eyelid.
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The treatment should be carried out 2 to 3 times a day for 10 to 15 days, until the chalazion disappears.
The location of the surgical incision
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A chalazion can become encysted. A mobile, painless, sometimes unsightly lump, whose size remains stable over time, then forms in the eyelid.
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This situation most often justifies an incision if one wishes to get rid of the chalazion. This procedure is performed under local anesthesia.
Schedule an appointment for an incision
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After the consultation, the surgeon will suggest a date for the incision if they deem it necessary. Otherwise, you will be advised to continue your medical treatment.
Eyelid care
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Eyelid care is part of the mechanical treatment of chalazion, but also of the eyelid hygiene routine in patients suffering from blepharitis and recurrent chalazia.
To perform effective eyelid care, you need to:
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Warm your eyelids with a cotton pad or a warm washcloth. Heatable eye masks are available in pharmacies (Therapearl® or BlephaEyeBag®) or online.
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Massage the eyelids using makeup removal motions: as if you wanted to remove scabs or makeup pencil from the edge of the eyelashes.
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Then rinse gently and instill a moisturizing eye drop (such as Vismed® or Thealose®).
Frequently Asked Questions
What are the causes of a chalazion?
A chalazion is caused by a blocked pore of a meibomian gland, similar to an acne pimple. It is most often caused by inflammation of the eyelid margin: blepharitis.
How to differentiate between a chalazion and a stye?
A chalazion and a stye are two inflammations of the eyelid:
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A chalazion is a cyst caused by a blockage of a meibomian gland. Its formation mechanism is similar to that of an acne pimple. It is deeper than a stye.
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A stye is an infection of the base of an eyelash. Its mechanism is the same as that of a boil.
How to treat a chalazion?
Treating a chalazion takes time! A minimum of 10 to 15 days of treatment is generally necessary to treat the inflammation and the cyst. The treatment is based on two essential principles that should not be overlooked:
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Mechanical treatment – Warm the chalazion with a cotton ball or warm washcloth for 2 to 3 minutes, then massage it by pressing from the outside of the eyelid towards the edge of the eyelid, as if you wanted to make it pop out. Repeat this treatment morning and evening;
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Anti-inflammatory treatment – This comes AFTER mechanical treatment. Once the chalazion has been massaged, apply a small amount of anti-inflammatory ointment to the swollen eyelid and, if necessary, into the eye (look upwards, pull down the lower eyelid, put the ointment in the cul-de-sac, then blink several times – then remove the excess ointment).
How to quickly cure a chalazion?
Some chalazia heal spontaneously without treatment in a few days. However, in the case of a fully formed chalazion, treatment unfortunately takes time (10 to 15 days on average). Focusing on mechanical treatment helps it drain. Do not try to puncture it with a needle, as this risks creating a fistula: a hole in the eyelid that constantly oozes meibum (a white fluid).
What is the best home remedy for treating a chalazion?
Many patients share their home remedies with us. The most effective is massaging with the back of a small, warm spoon. Indeed, warming the chalazion with a metal spoon dipped in warm water and then massaging it with a rigid instrument seems to be an effective mechanical treatment.
Chamomile and cornflower water have no known effect other than soothing the eyelids. Avoid them during the inflammatory chalazion phase.