The eyelids have different types of glands. The meibomian glands secrete and oily substance which is one of the components of tears. Another gland in the eyelid is the Zeis glands which secrete an oily reside from the hair follicles that comprise the eyelashes. When the meibomian glands and Zeis glands become blocked it causes lumps on the eyelids. This is sometimes mistaken for a stye but is a separate condition known as a chalazion.
What is a chalazion?
A chalazion is a small eyelid nodule that arises with inflammation and blockage of the meibomian or Zeis glands on the eyelids. Depending on which glands may be affected it is characterized as other superficial or deep. Inflammation and blockage of a meibomian gland causes a deep chalazion while a superficial chalazion is the result of a problem with the Zeis gland. Chalazions are also referred to as meibomomian cysts although his does not take into account problems with the Zeis glands.
Most of us known of eyelid problems like hordeolums (styes) but a chalazia (plural for chalazion) is also a common eyelid condition. It can affect both children and adults but tends to more frequently occur in the 30 to 50 year age group. Chalazia may be caused by a wide range of factor including poor hygiene, infections, skin diseases and even with stress. Overall chalazia are not serious conditions. It is easily treated and most cases resolve spontaneously.
Causes of Chalazion
There are a number of factors that contribute to the development of a chalazion. The meibomian glands are located more centrally compared to the Zeis glands that are located on the eyelid margin, at the root of the eyelashes. A chalazion occurs when these glands become obstructed. Therefore a chalazion emanating from a meibomian gland is more centrally located on the eyelid while that from the Zeis gland occurs towards the margins. However, it is possible for large centrally-located chalazion to extend all the way to the margin of the eyelid.
Skin diseases, particularly those involving the eyelid, are one of the possible causes of a chalazion.This includes skin conditions like seborrheic dermatitis and acne rosacea. Infections such as leishmaniasis, tuberculosis and various viral infections may also cause chalazia. The condition is also more common in people who are immune deficient, have cancer and with high blood cholesterol levels. Poor hygiene and stress are two well known causes although the exact role in chalazia development is unclear.
A chalazion is commonly mistaken for a stye but these are separate conditions. Sometimes chalazia can follow a stye or other eyelid conditions like blepharitis. However, it is possible for chalazia to occur spontaneously despite the absence of the causes and risk factors described above. Chalazia are more long term conditions than styes. There is chronic inflammation and the formulation of granuloma tissue that is not usually present in styes, which are more acute conditions.
Signs and Symptoms
The typical symptom of a chalazion is a lump on the eyelid. Most of the time the lump can be felt and sometimes it is also visible. The lump can reach 7 to 8mm in diameter. A chalazion can occur on either the upper or lower eyelid. However, it is more commonly found on the upper eyelid due to the larger number of meibomian glands. A chalazion is usually painless and can persist for long periods of time – weeks to months. At times it causes mild pain and irritation. However, once the chalazion becomes infected then there is significant pain.
Other symptoms include:
- Redness of the inner eyelid.
- Enlarged lymph nodes around the ear (if infection is present).
- Visual disturbance from large chalazion (rare).
Persistent chalazia, especially large lumps or those that become infected, can lead to various complications. Most of the time it is a cosmetic issue. However, chalazia can contribute to astigmatism as the lump presses against the cornea and distorts its surface. If the chalazion does not drain properly on its own it can lead to ingrowing or inversion of the eyelashes. There may also be a loss of eyelashes.
Treatment of Chalazia
Between 25% to 50% of all chalazia resolve on its own without any treatment. However, it may take an extended period of time to resolves, sometimes as 6 months or more. Many people may live with a chalazion without seeking medical attention unless it becomes too large, infected or there are cosmetic concerns. Most of the time it is advisable not to treat it if it is not causing any symptoms and not of significant cosmetic concern.
Simple measures like using a hot compress and proper eyelid hygiene may encourage draining of the chalazion. A hot compress should be held gently but firmly against the affected eyelid. This should be done for 5 to 10 minutes about 3 to 4 times a day. A cloth soaked in hot (not boiling) water makes a simple but suitable compress. Gently massaging the lump can also help with drainage but should be done carefully. The eyelid should be cleaned twice daily with a weak solution of warm water and baby shampoo.
Most of the time the lump is sterile meaning that it is free of infection. Using antibiotics drops will therefore not help. Antibiotics are only used when there is an infection. This may reduce the excess swelling, redness and pain but antibiotics will not treat the chalazion itself. Sometimes corticosteroids are used to reduce the chronic inflammation. However, this is not always necessary and should only be administered if advised by a medical professional.
In rare cases a surgical procedure may be needed to drain the chalazion. It is done by an eye specialist (opthamologist) under local anesthetic. The cyst is cut and drained. However, when the lump has hardened it may need to be cut out. A topical antibiotic is then applied to prevent an infection. Surgical drainage or removal is not a guarantee that a chalazion will not return. Recurrence is not uncommon. Therefor patients should be advised on preventative measures such as eye hygiene discussed above on an ongoing basis.