Chalazion

What is a chalazion?

Eye with upper eyelid chalazion

A chalazion is a small (2-8 mm) fluid-filled swelling (cyst) in the eyelid. It is common and sometimes called a meibomian cyst or tarsal cyst. A chalazion is more common on the upper eyelid. It is possible to have several at once, in more than one eyelid. It is not the same as a stye.

What's the difference between a stye and a chalazion?

A chalazion is caused by a blockage of a gland in the eyelid, whereas a stye is due to an infected follicle.

What causes a chalazion?

There are tiny glands just under the inner surface of the eyelid, called meibomian glands. These make an oily fluid called meibum to help lubricate the eye.

If the gland becomes blocked then the meibum cannot escape into the tears. It may expand into a swelling (cyst) and leak into the eyelid tissue. This becomes inflamed.

Over time, inflammation causes a lump (or granuloma) to form in the eyelid. This is a firm, solid lump that remains for a long time. This lump is the chalazion.

Chalazion is more common in people who have the eye condition blepharitis, or skin conditions such as eczema, because in these conditions the meibum tends to be thicker so the gland is more easily blocked.

See the separate leaflets called Stye and Blepharitis for more details.

What are the symptoms of a chalazion?

• The usual symptom is a small lump which develops on an eyelid.

• Sometimes it causes mild pain or irritation, particularly if it has just started - this usually settles.

• Rarely, it gets infected. It then becomes more swollen, red and painful.

• Sight is not affected, although very occasionally it can become big enough to press on the eyeball and distort vision.

What is the treatment for a chalazion?

No treatment may be necessary as up to half of people get better without any treatment. This can take between two and six months but if the chalazion is not causing any problems, it is probably best just to watch and wait. Further treatment options include:

• Warm compresses are a home treatment that help to ease discomfort. Hold a clean flannel that has been in hot water gently but firmly against the closed eye for 5-10 minutes, 3-4 times a day. Sometimes this warmth and slight pressure is enough to soften the contents of the fluid-filled swelling (cyst), helping it drain more easily. (The water should be hot but comfortable and not scalding.)

• Antibiotic ointments, drops and medicines are not recommended as they do not make any difference - the contents of the cyst are infection-free (sterile).

• Massage of the cyst after using a hot compress can encourage the cyst to drain. To do this, gently massage with a clean finger or cotton bud, in the direction of the eyelashes.

• Cleaning the eyelid twice per day removes grease and dead skin cells that may contribute to cysts forming. A weak solution of baby shampoo in warm water is ideal.

• A small operation is an option if it is troublesome or persistent. Your GP can refer you to an eye doctor (ophthalmologist) for this. The operation is usually done under local anaesthetic, although children and some adults may not tolerate this and may require general anaesthetic. The eyelid is numbed. A small cut is then made on the inside of the eyelid to release the contents of the cyst and it is scraped out. After surgery antibiotic drops or ointment are commonly prescribed.

Are there any complications?

Most chalazia cause no problems. Rarely, a cyst can become infected, and this infection can spread to involve the whole eyelid and tissues surrounding the eye. The eyelid may be very swollen and red.

It might be difficult to open the eye and there may be a lot of pain and a high temperature (fever). This type of complication is called orbital cellulitis and it is important to seek medical advice urgently, usually in an emergency department of a hospital. Treatment of orbital cellulitis is with antibiotics, usually into a vein (intravenously) via a drip, in hospital.

Will it happen again?

For most people a chalazion occurs just once. However, some people are prone to developing them and they may come back (recur). It is sometimes possible to prevent a chalazion developing by using a hot compress on the eyelids (described above) and massaging the eyelids each morning.

Dr Mary Lowth is an author or the original author of this leaflet.