Introduction
Chalazion, a common lid lump also called a tarsal or meibomian cyst, is a chronic non-infective (non-suppurative) lipogranulomatous inflammation of the meibomlan gland. This is the commonest of all lid lumps.
Etiology
- Predisposing factors are similar to hordeolum externum.
- Pathogenesis. Usually, first there occurs mild grade infection of the meibomian gland by organisms of very low virulence. As a result, there occurs proliferation of the epithelium and infiltration of the walls of the ducts, which are blocked. Consequently, there occurs retention of secretions (sebum) in the gland, causing its enlargement. The pent-up and extravasated secretions (fatty in nature) act like an irritant and excite non-infective lipogranulomatous inflammation of the blocked meibomian glands and surrounding tissue.
Clinical features
Symptoms include:
- Mild heaviness in the lid may be felt with moderately large chalazion.
- Painless swelling in the eyelid, gradually increasing in size is the main presenting symptom.
- Blurred vision may occur occasionally due to induced astigmatism by a very large chalazion pressing on the cornea. Watering (epiphora) may occur sometimes due to eversion of lower punctum caused by a large chalazion of the lower eyelid.
Signs include:
- Nodule is noted slightly away from the lid margin which is firm to hard and non tender on palpation. Upper lid is involved more commonly than the lower lid probably because of the fact that upper lid contains more meibomian glands than the lower lid. Frequently multiple chalazia may be seen.
- Reddish purple area, where the chalazion usually points, is seen on the palpebral conjunctiva after eversion of the lid.
- Projection of the main bulk of the swelling on the skin side may be seen rarely instead of conjunctival side.
- Marginal chalazion, occurring occasionally, may present as small reddish grey nodule on the lid margin.
Clinical course and complications
- Complete spontaneous resolution may occur rarely. Slow increase in size is often seen and eventually it may become very large.
- Fungating mass of granulation tissue may be formed occasionally when the lesion bursts on the conjunctival side.
- Secondary infection may lead to formation of hordeolum internum.
- Calcification may occur, though very rarely.
- Malignant change into meibomian gland adenocarcinoma (sebaceous cell carcinoma) may be seen occasionally in elderly people.
Treatment of Chalazion
- Conservative treatment. In a small, soft and recent chalazion, self-resolution may be helped by conservative treatment in the form of hot fomentation, topical antibiotic eyedrops and oral anti-inflammatory drugs.
- Intralesional injection of long-acting steroid ftriamcinolone) is reported to cause resolution in about 50% cases, especially in small and soft chalazia of recent onset, located near the puncta, where theision and curettage may cause damage.
- Incision and curettage is the conventional and effective treatment for chalazion.
- Surface anaesthesia is obtained by instillation of xylocaine drops in the eye and the lid in the region of the chalazion is infiltrated with 2% xylocaine solution.
- Incision is made with a sharp blade, which should be vertical on the conjunctival side (to avoid injury to other meibomian ducts) and horizontal on skin side (to have an invisible scar).
- Contents are curetted out with the help of a chalazion scoop.
- Carbolic acid cautery followed by neutralization with methylated spirit should be preformed in the cavity to avoid recurrence.
- Patching of eye should be done, after instilling antibiotic eye ointment, for about 6 to 12 hours.
- Postoperative treatment, to decrease discomfort and prevent infection, should be given in the form of hot fomentation, antibiotic eyedrops, oral anti inflammatory, analgesics and oral antibiotics for 4-5 days.
4. Diathermy: A marginal chalazion is better treated by diathermy.
5. Oral tetracycline should be given as prophylaxis in recurrent chalazia, especially if associated with acne rosacea or seborrheic dermatitis.
