Chalazion surgery – Surgical incision of the eyelid

A chalazion is a cyst of the eyelid. After an inflammatory phase lasting about 10 days, it evolves into a small, painless, and benign cyst within the eyelid. Nevertheless, it remains unsightly and bothersome. At the end of treatment, continue to massage the chalazion after showering. If the cyst does not disappear after 3 to 4 weeks and is causing you discomfort, you can consider an incision. This is a minor surgical procedure performed in a sterile room under local anesthesia of the eyelid. The chalazion is pinched and then drained through the underside of the eyelid to avoid scarring. You will leave with a bandage to minimize the risk of bleeding. The eyelid will return to normal after 7 to 10 days.

What is a chalazion?

This is a cyst that develops at the expense of the Meibomian glands, contained within the thickness of the eyelids.
The occurrence of this cyst is due to a dysfunction of these glands, which become blocked, trapping their fatty contents (Meibum) within them.
This results in local inflammation causing swelling and pain in the eyelid.
The classic evolution of a chalazion is regression until total disappearance, thanks to local treatment based on eyelid care and cortico-antibiotic ointment.
Healing typically occurs within a few days but can take up to a month depending on the case. An article dedicated to chalazia, explaining its causes, symptoms, and medical treatments, is available on our website by following this link.
The evolution of a chalazion can also lead to "encystment": the chalazion no longer regresses despite treatment, persisting in the thickness of the eyelid, in the form of a localized, rounded (small hard) and painless induration.
An "encysted" chalazion then requires surgical treatment, the details of which we will explain below.

Why is surgery necessary?

A persistent encysted chalazion causes primarily aesthetic discomfort.
In some cases the discomfort can also be functional, manifesting as visual fatigue, a feeling of heaviness in the eyelid or an inflammatory recurrence.
The aim of the surgical intervention is therefore to accelerate recovery, and to prevent the chalazion from persisting in a chronic manner.

When is surgery necessary?

The presence of an indurated cyst at 6 weeks of evolution makes spontaneous regression or regression under medical treatment unlikely: this is the best surgical indication for chalazion.
An encysted chalazion is by definition not inflammatory: a cyst felt through the skin of the eyelid, painless to the touch, with the overlying skin not being red.

When should surgery be avoided?

Chalazion surgery is justified when it represents the only way to quickly eliminate a chalazion that does not regress or only slightly regresses under medical treatment.
It is not considered in the following cases:

Chalazion that has been evolving for less than 6 weeks or that is gradually regressing – It is advisable to continue drug treatment with eyelid care, as the probability of improvement remains significant.
A very small chalazion (not visible to the naked eye but perceptible to the touch) – The outcome is generally favorable without treatment, but it takes more than 6 weeks. Surgery is not recommended, as the risk of failure (chalazion is difficult to locate) is significant. The best approach is simply to monitor its progress by massaging the eyelids with warm water.
Inflammatory chalazion – Medical treatment should be continued until the inflammation subsides before considering surgery. Surgical intervention on an inflamed eyelid is associated with a more complex recovery.
Fistulated chalazion (with drainage to the skin, or a crust) – It is advisable to continue medication to encourage the natural drainage of the chalazion. Surgery for a fistulated chalazion results in significant damage to the eyelid (even if it eventually heals), with a longer healing period. Furthermore, spontaneous fistulization allows the chalazion to drain, and therefore to regress with massage.
Multiple chalazia occurring simultaneously in the same eye, with multiple recurrences: long-term treatment is necessary to prevent the appearance of new chalazia; surgery does not prevent recurrence. Prescribing appropriate eyeglasses also helps reduce the likelihood of recurrence.

What does the surgery involve?

Conventional surgical treatment consists of evacuating the contents of the chalazion and the capsule that contains it, via the conjunctival route (on the inner surface of the eyelid), after performing local anesthesia of the eyelid.
For small chalazia, small recurrences, or multiple and inflammatory chalazia, treatment consists of an intratarsal and subcutaneous injection of corticosteroids (KENACORT®), the aim of which is to dissolve the contents of the chalazion, without resorting to an incision.

How does the procedure unfold?

The procedure is performed on an outpatient basis, in the office, under local anesthesia, in a dedicated operating room.
Mild premedication is often prescribed, taken two hours before the procedure, to reduce patient anxiety.
After the patient has read and signed the consent form, the procedure begins with an examination by the surgeon, who will determine if the surgical indication is still relevant, as the chalazion may have changed between the time of booking the appointment and the day of surgery.
It sometimes happens that a planned operation is cancelled because the chalazion has regressed.

The incision of the chalazion

After the surgeon has assessed the operability, the procedure can take place according to the following sequence, which lasts approximately 10 to 15 minutes in total:

Injection of a local anesthetic into the affected eyelid opposite the chalazion: this step is painful for a few seconds, the time required for the anesthetic to take effect.
Surgical incision and evacuation of the chalazion: this step is usually sensitive, but not painful.
The chalazion is pinched using chalazion forceps.
The eyelid is everted.
The chalazion is incised at the level of the conjunctiva.
The cyst is removed using a chalazion curette.
After the incision, the surgeon applies an anti-inflammatory ointment and then an eye dressing at the end of the procedure.
The dressing is intended to stop postoperative bleeding and should be kept in place for 2 to 3 hours after the procedure.

What are the next steps after the procedure?

Post-operative bleeding usually stops within a few hours of the procedure. It is recommended to avoid applying heat to the eyelids and instead use cold compresses for 48 hours.
A hematoma of the eyelid is systematic postoperatively; it is more or less significant depending on the volume of the chalazion operated on and the coagulability of each patient's blood.
Post-operative anti-inflammatory treatment is prescribed for about ten days to reduce pain and swelling of the eyelid. However, some patients may experience pain in the hours following surgery, but this usually disappears after taking paracetamol.
The eyelid hematoma disappears completely in one to two weeks.
The eyelid usually returns to a normal appearance within 1 to 4 weeks. In some cases, the healing process may lead to the formation of fibrosis, which the patient feels as a small residual "lump": this usually disappears within 6 weeks.
In the case of KENACORT® injection, the product remains visible under the skin as white spots, disappearing in 4 to 8 weeks.

What are the possible complications?

The main risk of the procedure is recurrence or incomplete drainage, occurring in approximately 5 to 10% of cases, particularly with extreme chalazia (very large or very small). In such cases, your surgeon will generally recommend a simple corticosteroid injection into the eyelid at least one month after the initial procedure, with the aim of dissolving the remaining chalazion.
In cases of persistent fibrosis lasting more than 6 weeks, this same treatment may be offered to accelerate recovery.
The indentation in the eyelid causes a slight deformation of the eyelid, which disappears spontaneously after a few weeks.
Surgical site infection is very rare after chalazion surgery: it is treated with antibiotics.

What post-operative precautions should be taken?

The patient leaves the office with a bandage covering the eye on the operated side, which prohibits any driving for half a day: public transport should therefore be preferred.
Depending on the professional activity, the patient can return to work the next day: a work stoppage is only essential for jobs that require being in a dusty environment or in the event of particularly significant postoperative inflammation, which is very rarely observed.
Consistent application of postoperative treatment is essential for a rapid recovery.
It is advisable to avoid wearing makeup, going in the water (swimming pool, sea) or immersing your face in water (washing your hair with your head back) for 15 days following the procedure.
Finally, wearing contact lenses is permitted from the 15th day after the procedure.

How can we prevent the occurrence of future chalazia?

Chalazia typically occur against a background of chronic eyelid inflammation, exacerbated by both intrinsic and environmental factors. Patients are therefore prone to recurrence, which is why prevention plays a crucial role in their management. Generally, it is recommended to perform eyelid cleansing with warm water at least once a day.
In cases of blepharitis or chronic eyelid inflammation, long-term treatment with eye drops or tablets may be considered. Finally, refractive errors such as astigmatism, hyperopia, or presbyopia must be properly corrected to reduce the risk of recurrence.

Sources:
https://eyewiki.org/Category:Articles
https://www.cahiers-ophtalmologie.fr/
https://snof.org/
https://couf.fr/