CHALAZION

It is also called a tarsal or meibomian cyst. It is a
chronic non-infective granulomatous inflammation of
the meibomian gland.
Etiology
1. Predisposing factors are similar to hordeolum
externum.
2. 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 secretions (fatty in nature) act like an
irritant and excite non-infective granulomatous
inflammation of the meibomian gland.
Clinical picture
Patients usually present with a painless swelling in
the lid and a feeling of mild heaviness. Examination
usually reveals small, firm to hard, non-tender swelling
present slightly away from the lid margin (Fig. 14.12).
It usually points on the conjunctival side, as a red,
purple or grey area, seen on everting the lid. Rarely,
the main bulk of the swelling project on the skin side.
Occasionally, it may present as a reddish-grey nodule
on the intermarginal strip (marginal chalazion).
Frequently, multiple chalazia may be seen involving
one or more eyelids.
Clinical course and complications
Complete spontaneous resolution may occur
rarely.
Often it slowly increases in size and becomes
very large. A large chalazion of the upper lid may
press on the cornea and cause blurred vision
from induced astigmatism. A large chalazion of
the lower lid may rarely cause eversion of the
punctum or even ectropion and epiphora.
Occasionally, it may burst on the conjunctival
side, forming a fungating mass of granulation
tissue.
Secondary infection leads to formation of
hordeolum internum.
Calcification may occur, though very rarely.
Malignant change into meibomian gland
carcinoma may be seen occasionally in elderly
people.
Treatment
1. 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.
2. Intralesional injection of long-acting steroid
(triamcinolone) is reported to cause resolution in
about 50 percent cases, especially in small and
soft chalazia. So, such a trial is worthwhile before
the surgical intervention.
3. Incision and curettage (Fig. 14.13) 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 percent
xylocaine solution. An 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). The contents are curetted
out with the help of a chalazion scoop. To avoid
recurrence, its cavity should be cauterised with
carbolic acid. An antibiotic ointment is instilled
and eye padded for about 12 hours. To decrease
postoperative discomfort and prevent infection,
antibiotic eyedrops, hot fomentation and oral
anti-inflammatory and analgesics may be given
for 3-4 days.
4. Diathermy. A marginal chalazion is better treated
by diathermy.