Chalazion (Eyelid Cyst)

What a chalazion is

Each upper eyelid has about 25 to 40 meibomian glands, and each lower lid about 20 to 30. They sit in a plate of firm tissue called the tarsus and release an oily film onto the edge of the lid. That oil stops tears from evaporating.

When a gland opening becomes blocked, oil backs up inside the gland. The gland can rupture into the surrounding tissue, and the body walls off the oil with a type of chronic inflammation called a lipogranuloma. The result is a round, rubbery lump. It is not caused by infection, which is the main difference from a stye.

Thick oil secretions from meibomian gland dysfunction are the most common background problem. This is why chalazia often come in crops or keep recurring.

Chalazion vs stye

A stye can turn into a chalazion once the infection settles and leaves a hard lump.

Symptoms

• A smooth, round lump in the upper or lower lid, from a few millimeters to about 1 cm across
• Mild tenderness or redness in the first few days, then usually painless
• Swelling of the lid around it
• A red or gray spot on the inner surface of the lid when it is turned out
• Blurred vision, if a large upper-lid chalazion presses on the cornea and changes its shape (astigmatism)
• Watery eye or a feeling of heaviness in the lid

Causes and risk factors

• Blepharitis, inflammation of the lid margins with crusting
• Rosacea, especially ocular rosacea
• Seborrheic dermatitis and oily skin
• A previous chalazion or stye
• Rubbing the eyes or using old eye makeup
• Rarely, conditions that thicken gland secretions, and some cancer drugs

Diagnosis

A chalazion is diagnosed by looking at the eyelid, often with a slit lamp microscope. No tests are needed for a typical lump.

An eye doctor will want to biopsy a lump that keeps coming back in the same place, especially in an older adult, or that has lost lashes or ulcerated. Rarely, a cancer of the oil glands called sebaceous gland carcinoma can look exactly like a recurrent chalazion.

Treatment

Home treatment

• Warm compresses: hold a clean washcloth soaked in warm (not hot) water, or a microwaveable eye mask, on the closed eyelid for 10 to 15 minutes, 3 to 4 times a day. Rewarm it as it cools. The heat softens the thick oil.
• Lid massage: after each compress, massage the lump gently with a clean fingertip toward the lid edge for about 30 seconds.
• Lid hygiene: clean the lash line once or twice a day with diluted baby shampoo or a commercial lid cleanser.
• Avoid eye makeup and contact lenses until it settles.
• Do not squeeze it. This can spread inflammation.

With consistent care, many chalazia shrink within a few weeks.

Medical treatment

• Steroid injection: a small injection of triamcinolone into the lump can shrink it within 1 to 2 weeks. It may lighten the skin in people with darker skin.
• Incision and curettage: a minor procedure under local anesthetic. The lid is clamped and turned out, a small cut is made on the inside, and the contents are scraped out. There is no visible scar. The eye may be patched for a few hours.
• Antibiotics are only needed if the lid becomes infected. Oral doxycycline or azithromycin are sometimes prescribed for their anti-inflammatory effect in people with rosacea or recurrent chalazia.
• Treating the cause: long-term lid hygiene and management of blepharitis or rosacea reduce recurrences.

Complications

Chalazia are harmless in most cases. Possible problems include:

• blurred vision or astigmatism from pressure on the cornea
• in young children, a large upper-lid chalazion that blocks the pupil can cause a lazy eye (amblyopia) and needs prompt treatment
• secondary infection, which can spread to the lid as preseptal cellulitis
• recurrence, especially without lid hygiene

Prevention

• Keep up daily warm compresses and lid cleaning if you are prone to chalazia.
• Treat blepharitis, rosacea and dry eye.
• Replace eye makeup every 3 months and remove it fully before sleep.
• Wash your hands before touching your eyes or handling contact lenses.

Frequently asked questions

What is the link between a chalazion and the oil glands?

A chalazion forms when one of the meibomian oil glands in the eyelid gets blocked. The trapped oil leaks into nearby tissue and causes a walled-off, non-infected inflammation. People with thick gland secretions from blepharitis or rosacea get them more often.

How long does a chalazion last?

Many settle within 2 to 8 weeks with warm compresses and massage. Some last for months. If one has not improved after about 4 to 6 weeks of home treatment, an eye doctor can offer a steroid injection or a quick drainage procedure.

Is a chalazion contagious?

No. A chalazion is not an infection, so it cannot spread to other people or to the other eye. A stye, which is a bacterial infection, is also not considered very contagious, though sharing towels or makeup is best avoided.

Can I pop a chalazion?

No. A chalazion is a firm lump of thickened oil and inflammation, not a pimple, and squeezing it does not drain it. It can cause more swelling, scarring or infection. Use warm compresses, or have it drained by an eye doctor.

Will a chalazion affect my vision?

A small one will not. A large chalazion on the upper lid can press on the front of the eye and cause blurring, which clears once the lump is treated. In young children, an eye doctor should check that it is not blocking vision.