BASICS

DESCRIPTION

A chalazion, or internal hordeolum, is a localized inflammatory papule of the posterior eyelid due to obstruction of the meibomian (sebaceous) glands. In contrast, an external hordeolum or stye, is an inflammatory lesion of the anterior eyelid due to obstruction of the glands of Moll (sweat gland) and Zeis (sebaceous).

EPIDEMIOLOGY

Incidence

Most common eyelid lesion

RISK FACTORS

• Poor lid hygiene

• Acne Rosacea

• Dry eye syndrome

GENERAL PREVENTION

• Good lid hygiene

• Treatment of rosacea (oral tetracycline)

• Treatment of dry eye syndrome

PATHOPHYSIOLOGY

Obstruction of the meibomian gland orifice prevents normal egress of sebaceous holocrine secretion at the lid margin, eliciting a lipogranulomatous foreign body reaction.

ETIOLOGY

Obstruction of the meibomian glands either from the bacteria (S. aureus, Strep) and/or from the associated inflammation.

COMMONLY ASSOCIATED CONDITIONS

• Chronic bacterial blepharitis

• Chronic allergic blepharoconjunctivitis

• Chronic keratitis sicca

• Acne Rosacea

• Lid malposition

• Lid trauma

DIAGNOSIS

HISTORY

• Tender swelling, erythema (acute)

• Non tender eyelid lump (chronic)

• Exposure to dusty environment

• Blurred vision (possible induced astigmatism)

PHYSICAL EXAM

• Eyelid swelling and erythema (acute, subacute)

• Localized eyelid tenderness

• Well-defined subcutaneous lid nodule (chronic)

• Blocked meibomian gland orifices

• Associated blepharitis or acne rosacea

DIAGNOSTIC TESTS & INTERPRETATION

Imaging

CT scan orbit if suspect orbital cellulitis

Diagnostic Procedures/Other

Biopsy recurrent lesions to rule out meibomian gland carcinoma

Pathological Findings

Zonal granulomatous inflammatory reaction. Central clear space, surrounded by histiocytes and Langhans’ multinucleated giant cells, surrounded by PMNs, leukocytes, plasma cells, and eosinophils. Asteroid bodies and Schaumann bodies may also be present.

DIFFERENTIAL DIAGNOSIS

• Meibomian gland (sebaceous cell) carcinoma

• Preseptal cellulites

• Adenovirus conjunctivitis

• Pyogenic granuloma

TREATMENT

MEDICATION

First Line

• Warm compresses q.i.d × 2 weeks (10 min each)

• Sulfacetamide 10% 1gtt. q.i.d × 2 weeks or prednisolone 0.2%/sulfacetamide 10%, if no contraindication to topical steroids

• Alternative: Bacitracin or erythromycin ointment b.i.d

Second Line

• Surgical incision and curettage

• Triamcinolone acetonide intralesional injections

ADDITIONAL TREATMENT

General Measures

Biopsy recurrent lesions

Issues for Referral

• Recurrent lesion

• Suspect meibomian gland carcinoma

• Treatment of acne rosacea

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Every 2 weeks as outpatient to monitor progress.

PROGNOSIS

Excellent.

COMPLICATIONS

• Entropion

• Lid scar

ADDITIONAL READING

• Bagheri A, Hasani HR, Karimian F, et al. Effect of chalazion excision on refractive error and corneal topography. Eur J Ophthalmol 2009;19(4):521–6.

• Goawalla A, Lee V. Prospective randomized treatment study comparing three treatment options for chalazia: Triamcinolone acetonide injections, incision and curettage and treatment with hot compresses. Clin Experiment Ophthalmol 2007;35(8):706–12.

• Ben Simon GJ, Huang L, Nakra T, et al. Intralesional triamcinolone acetonide injection for primary and recurrent chalazia: Is it effective? Ophthalmology 2005;112(5):913–7.

CODES

ICD9

• 373.2 Chalazion

• 373.12 Hordeolum internum

CLINICAL PEARLS

• Most common inflammatory lid lesion

• Recurrent chalazia need biopsy to rule out meibomian gland carcinoma

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