Eyelid Inflammation
CHALAZION
A type of focal inflammation of the eyelid; it is a common lesion of the eyelid. The most common cause is blockage of a meibomian gland of the eyelid. Chalazia can present with an inflamed, tender, red eyelid or as a discrete nontender lump in the eyelid.
Epidemiology and Etiology
• Age: Any
• Gender: Equal
• Etiology: Focal inflammation of the eyelid resulting from the obstruction of the meibomian glands
History
• Often present with acute onset of focal eyelid inflammation. The inflammation will resolve but may turn into a chronic cyst-like lesion.
• The onset may be more insidious with the appearance of the cyst-like lesion with minimal inflammation.
Examination
• In the acute process, the eyelid may be diffusely inflamed with pain focally over the involved area (Fig. 2-1A). There may be pointing over the blocked meibomian gland.
• As the inflammation resolves, the resulting lesion is a firm mass in the tarsal plate with or without residual inflammation (Fig. 2-1B).
Special Considerations
• Chronic, nonresolving chalazion needs to be biopsied to rule out a carcinoma.
Differential Diagnosis
• Sebaceous adenocarcinoma
• Squamous cell carcinoma
• Basal cell carcinoma
Pathophysiology
• Blockage of the eyelid glands results in release of the gland contents into the tarsus and eyelid, resulting in an inflammatory process.
• The inflammatory process is then walled off with time, resulting in the cyst-like lesion.
• The exact role of bacteria in this process is unclear.
Treatment
• In the inflammatory phase, initial treatment is warm compresses and steroid antibiotic drops or ointment.
• As the lesion becomes cystic, treatment is then excision via a conjunctiva incision.
• Injection of steroid into the lesion may also be effective. Steroid injections need to be used cautiously in patients with darkly pigmented skin, because they can cause depigmentation.
 FIGURE 2-1. Chalazion. A. A firm, formed lump of the left lower eyelid. There is still some inflammation of the chalazion. The eye is red from blepharoconjunctivitis, which often is part of a chalazion. Most of the time, the eye is white and quiet. B. A chronic chalazion of the left upper eyelid with some crusting over the chalazion from external drainage.
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