A Chalazion is a lump or a cyst on the eyelid. It is also known as Meibomian Cyst or Tarsal Cyst.
The central round part of the eye that is colored is called the cornea. Sclera is the white part around the cornea. The outer surface of both the cornea and sclera is covered by a ‘tear layer’. It is a fluid layer that prevents the eyes from drying. The tear layer is formed by watery secretion from lacrimal glands (present in upper and outer part of the eyes) and oily secretion from several other glands present along the upper and the lower eyelids. These other glands are present on the inner side of eyelids (meibomian glands), and along the eye lid margin at the base of the eyelashes. They are referred as the glands of zeis and moll.
Chalazion develops due to the obstruction of an oil gland in the upper or the lower eyelid. It may be present on the inner side or along the margin of the eyelids.The lump is usually painless and may increase in size over days to weeks.
Chalazion forms more commonly in upper eyelids. Chalazia may occur at any age but they are more common between thirty and fifty years of age.
Chronic condition (slow onset and stays for a long time), non-infectious origin, non-contagious, non-genetic.
There is blockage and swelling of one or more glands that are present along the eyelids. This results in the formation of a painless firm nodule present on the inner side of the eyelidor along the eyelid margin. There may be visual blurring but it does not cause permanent loss of vision.
The glands present in the eyelids produce oil like substance (sebum) that exits from each gland through a tiny opening. Sebum lubricates the eyes and prevents them from drying. The opening of the gland may be blocked if sebum becomes too thick to flow out or if there is any inflammation in the eyelids. Because of the blockage, oil accumulates inside the gland forming a painless lump. The wall of the gland may break, releasing the oil into the tissue of the eyelid, which causes inflammation. This condition may persist for a long time resulting in formation of a nodule.
Depending on the location, Chalazion may be of two types:
Superficial Type: It occurs due to blockage of glands present along the lid margin (glands of zeis and moll). Such chalazia are usually smaller and grow towards the outer side of the lid margin.
Deep Type: It occurs due to blockage of glands present on the inner side of the eyelids (meibomian glands). Such chalazia are usually larger and grow on either side of the lid margin.
There are some risk factors which increase the chances of developing Chalazion. However, people who do not have the risk factors may also develop the condition. Some such factors are:
Chalazia may occur in people who have inflammation of eyelids from a long time, such as in the cases of Chronic Blepharitis. Inflammation causes swelling, and blocks the opening of the glands of the eyelids.
Stye is a reddish, painful, swollen bump or nodule along the eyelid margin that forms due to infection of the glands of the eyelid. Stye causes scarring of the eyelid glands, which may block the openings of the glands of the eyelids.
In people with Seborrhea, there is excessive production of sebum or oily substance in the skin or in the glands of the eye. People who have high levels of lipids in the blood have thicker secretions from the oil glands, including those of the eyelids. may block the openings of the glands of the eyelids resulting in Chalazion. Chances of blockage are also higher in people having excess dandruff (Seborrhoeic Dermatitis). Rosacea may also cause Chalazion when the eyes are involved.
Chronic infections such as Leishmaniasis, Tuberculosis, or Viral infection of the eyes also increase the chances of developing Chalazion. This probably occurs due to the swelling of the gland openings, which happens in response to the infection.
Conditions such as Diabetes Mellitus, under nutrition or other chronic (long term) illnesses reduce the immunity and increase the chances of developing Chalazion among other infections. Children with Hyper-IgE Syndrome (also known as Job Syndrome) may develop chalazia frequently.
Rubbing the eyes frequently, working in dusty environment, or high exposure to sunlight results also increase the chances of developing Chalazion.
Chalazion usually appears as a painless bump or nodule on the margin or inner side of the eyelid. The bump may be soft or hard and enlarges over days to weeks, slowly. There may be pain on pressing on the swelling. There may be irritation or foreign body sensation in the affected eye. Excessive watering and sensitivity to light (photophobia) may also be present. When the Chalazion presses upon the eye, it may blur the vision.
The Chalazion may become painful, red and warm to touch, if there an infection to the blocked oil gland.
Medical history and previous episodes of Chalazion are important information for diagnosis. The eyes are examined to find any painless, firm bumps present inside or along the eyelid margin. The eyelids may have to be inverted to find Chalazion that is deep. Any symptoms of Rosacea, Seborrhea or Seborrhoeic Dermatitis are also checked.
Apart from that, Visual Acuity Testing may be done to assess the vision of the person. The doctor may ask the person to look at a chart and read the letters or numbers on it from a distance of around six meters. Both the eyes are tested individually.
Usually no further testing is needed. However, if the doctor is unsure about the diagnosis, Fine-Needle Aspiration Cytology may be done. It involves inserting a needle into the Chalazion to obtain a small tissue sample. The sample is examined under a microscope to look for symptoms suggestive of Chalazion. This test also helps to rule out other conditions such as such as Sebaceous or Squamous Cell Carcinomas.
The aim of treatment is to relieve the symptoms, remove the blockage, and prevent complications.
Eyes should be kept clean and washed regularly. Baby shampoo may be used to wash the affected eyelid.
The doctor may advise application of warm compresses or plain washcloth dipped in hot water on the affected area for fifteen minutes, about 4 to 6 times a day. Application of heat relieves swelling, reduces blockage and aids in drainage of the sebum accumulated inside the gland. Healing is faster with regular heat application.
Gentle massaging of the chalazion may be done for a few minutes several times during the day.
Most cases resolve by following these measures. Further treatment may be needed if the Chalazion persists or if it is large in size.
Eye drops containing antibiotics may be given. These medications do not cure Chalazion but prevent or cure infection. If there is infection, pain killers may be given to reduce the pain, redness, or swelling.
A full course of antibiotics may be given orally to prevent secondary infection or recurrence of infection. This may also be needed if the skin of the eyelid (called as cellulitis) is infected, apart from Chalazion.
Steroids may be injected into the Chalazion. They decrease the size of chalazion by reducing the inflammation and swelling. These injections may be especially needed for a large Chalazion.
Surgery may be needed if the Chalazion does not resolve by medical measures. A typical surgery involves making a small cut on the skin of eyes or the conjunctiva (layer on the inside of eyelids) overlying the Chalazion. Through the cut, Chalazion is removed completely. It is usually performed under local anesthesia.
Improper drainage of Chalazion may result in infection. Infection may result in formation of a stye or a hordeolum. The affected eyelid turns red, painful and warm to touch. The skin of the eyelid (called as cellulitis) may also be infected.
Chalazia may be recurring in some people, particularly those who have Hyper-IgE Syndrome, Diabetes, Leishmaniasis, Tuberculosis, viral infection of the eyes, or Seborrhoeic Dermatitis. This also happens in people who are under nourished.
Chalazion may result in disfigurement of the eyelids. Growth of eyelashes may be disrupted. A hole may also form in the eyelid.
Steroid injections given into the Chalazion may result in discoloration of the eyelid. There may be damage to the cells of the eyelid margin. In some cases, there may be injury to the eye, or damage to the cornea.
Certain simple measures reduce the chances of blockage of the glands of the eyelids. One should wear sunglasses when working in dusty environments or while driving, to prevent dust from entering the eyes. Eyes should be washed after coming from outside. Frequent rubbing of eyelids should be avoided. Reduce exposure of eyes to sunlight by using sunglasses or wide-brimmed hats.
One should manage the associated conditions such as Diabetes, Rosacea, or Seborrhoeic Dermatitis that may result in formation of Chalazion. Baby shampoos may be used to wash the eyelids, especially in people having Seborrhea or Seborrhoeic dermatitis. This reduces the blockage of the gland openings.
The Chalazion should not be pressed or squeezed. One should wash his/her face and eyes regularly. Contact lenses and any eye makeup should be avoided till the Chalazion heals.
A person who is undergoing treatment for Chalazion should contact a doctor if the swelling remains for a long time or if additional symptoms such as fever, headache or blurring of the vision occur. Also, if there is pain or redness Chalazion, a doctor must be consulted.
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