Chalazion
Jill C. Cash and Mellisa A. Hall
Definition
A.Chalazion is a chronic inflammatory lesion due to meibomian tear gland obstruction. Chalazions are located in the eyelid margin. A hordeolum (stye) may scar and turn into a chalazion.
Incidence
A.The incidence is unknown.
Pathogenesis
A.Meibomian glands secrete the lipid layer of the tear film that covers and protects the eye. When the glands become blocked, the oil or lipid extrudes into the surrounding tissue, causing the formation of a painless, rubbery nodule.
Predisposing Factors
A.Chalazion may occur as a secondary infection of the surrounding tissues (stye). Chalazions occur more frequently in patients with blepharitis and rosacea.
Common Complaints
A.Swelling, nontender palpable nodule, usually pea-size, inside lid margin or eye.
B.Discomfort or irritation due to swelling.
Other Signs and Symptoms
A.Tearing.
B.Feeling of a foreign body in the eye.
C.If infection is present, the entire lid becomes painfully swollen.
Subjective Data
A.Review onset of symptoms, their course and duration, and any concurrent visual disturbance.
B.Question the patient regarding possible foreign body or trauma to the eye.
C.Elicit the quality of pain or tenderness of the eyelid.
D.Review past eye problems and the treatment received.
E.Question for eye tearing, discharge, or matting.
F.Question for employment duties and hobbies predisposing to foreign bodies.
Physical Examination
A.Temperature.
B.Inspect:
1.Inspect the eye, sclera, and conjunctiva for a foreign body, erythema, vessel injection, discharge, matting, inflammation of the eyelids, or pterygium.
2.Check for red- or gray-colored subconjunctival mass in upper and lower eyelid.
C.Palpate:
1.Palpate eyelid for masses, foreign body sensation, and tenderness.
2.Check for preauricular adenopathy. Usually a hard, nontender nodule is found on the middle portion of the tarsus, away from the lid border; it may develop on the lid margin if the opening of the duct is involved. Some chalazia continue to increase in size and can cause astigmatism by putting pressure on the eye globe.
3.Chalazia may become acutely tender; however, note the difference between the chalazia and the stye, which is found on the lid margin.
Diagnostic Tests
A.Perform visual acuity exam.
Differential Diagnoses
A.Chalazion.
B.Chronic dacryocystitis.
C.Hordeolum.
D.Blepharitis.
E.Xanthelasma.
Plan
A.General interventions:
1.Small chalazia do not usually require treatment.
2.Warm, moist compresses may be applied for 15 minutes four times a day.
B.Patient teaching:
1.Instruct patient regarding use of warm compresses and good handwashing.
C.Pharmaceutical therapy:
1.Antibiotic treatment is not recommended as chalazion is a granulomatous condition.
2.Intrachalazion corticosteroid injection by an ophthalmologist may be considered.
Follow-Up
A.For large chalazia, follow up with patient in 1 week and then evaluate the patient every 2 to 4 weeks.
Consultation/Referral
A.Refer to ophthalmologist.
Individual Considerations
A.Geriatrics:
1.Nonpharmacological treatments include warm compresses for 20 to 30 minutes (rewetting washcloth every 5–10 minutes), applying a gentle massage, discontinuing wearing contact lens and eye makeup until healed, and encouraging patients to keep hands clean and to not rub their eyes.
2.Pharmacological treatment common for geriatrics: Short-term nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation and Tobradex® ointment three to four times a day for 1 week (combination of an antibiotic and anti-inflammatory).