Chalazion Injection

Indications and Clinical Considerations

Chalazion is the most common form of focal swelling of the eyelid. Chalazia (the plural form of chalazion) are characterized by firm, painless, eyelid nodules that can occur on the upper or lower eyelid ( Figs. 4.1 and 4.2 ). Chalazion, which is also known as a conjunctival granuloma, is the result of a noninfectious granulomatous inflammatory response. It is most commonly caused by obstruction of the sebaceous glands of the eyelids by retained sebaceous secretions. Other causes of chalazion are listed in Box 4.1 . Chalazion occurs more commonly in adults but can be seen in adolescents, especially at the time of puberty, and in children.

Superficial chalazion occurs as a result of obstruction of the Zeis gland and is usually located along the lid margin ( Fig. 4.3 ). Deep chalazion is the result of obstruction of the tarsal meibomian gland and is usually located on the conjunctival portion of the eyelid (see Fig. 4.3 ). Unlike hordeolum, which is the result of an acute pyogenic infection of the eyelid with associated painful eyelid swelling, chalazion tends to be less painful and less inflamed with a much more gradual onset over weeks to months ( Figs. 4.4 and 4.5 ). Occasionally, chalazion can become acutely infected, confusing the diagnosis. Chalazion can recur, but recurrence should be considered an indication for more careful evaluation of the eyelid lesion to rule out malignancy such as sebaceous carcinoma and other causes of focal eyelid swelling, especially in elderly patients ( Fig. 4.6 ).

Initial treatment of asymptomatic chalazion should include gentle eyelid massage, moist heat, and reassurance. A short course of ophthalmic steroid drops or ointment may be used if the chalazion is inflamed. For lesions that are symptomatic or that fail to respond to conservative therapy, an intralesional injection with depot steroid or incision and curettage are reasonable next steps.