Chalazion – Causes, Pathogenesis, Symptoms, Treatment

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Chalazion is a disorder of eyelids. It is a small lump / swelling on the eyelid. It is caused due to the block in the gland(s) of the eye. It is the most common types of eyelid lumps.
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Introduction, causes

Chalazion is a small painless lump or swelling. Inflammation of meibomian gland of the eye lid leading to blockage of its duct leads to this condition. Chalazion is a single lump. When they are many in number, they are called Chalazia. Many times chalazion may not need a treatment. It often disappears without treatment. When it seems to be coming in the way of vision, one should see a doctor.
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Chalazia / chalazion mostly occur on the upper eyelid but they are also sometimes seen to occur on the lower eyelid. They may manifest in the eyelid of one eye, but sometimes they are also seen to occur on the eyelids of both eyes simultaneously. Chalazion may either be soft or firmer. When it is soft, it is often filled up with fluid.

Chalazion need not be feared for; it doesn’t cause permanent changes in the vision. It will also not interfere with vision.
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Other Names –

• Meibomian cyst
• Tarsal cyst
• Conjunctival granuloma
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Causes and pathogenesis –
The term chalazion is derived from Greek word Khalazion, which means ‘small hailstone’.

As said, chalazion is caused when a block occurs in one of the meibomian glands of the eyelids. These glands are present in both upper and lower eyelids. They produce a kind of oil which, along with tears, lubricates and moistens the eyes and also protect them. If the oil becomes too thick, it can block the glands leading to causation of chalazion. The glands also may get blocked due to inflammation.
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Usually the meibomian glands are involved. The gland of Zeis may also be involved in rare cases. Sometimes chalazion is caused due to infection but infection is a rare cause.

Frequent or past infections and viruses affecting these glands are the causes of chalazia. Chalazia are said to be related to common inflammatory conditions like acne, chronic blepharitis, seborrhea etc and are seen in those who suffer from these conditions. Infection of the eyes and eyelids and viral conjunctivitis also cause chalazia many times.
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Symptoms, risk factors

Symptoms of chalazion
Chalazion is seen to occur more in adults in comparison to the children, but happens in both age groups. It starts with a small, red, swollen and tender lump / sore. The lump remains after some days after the pain fades away. Thus, chalazia include painless lump and swelling of upper or lower eyelids.
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The symptoms of chalazion / chalazia include –

• Small lump / sore on the eyelid, upper or lower
• Swelling of the affected eyelid
• Redness of the eyelid and eye
• Watering of the eye
• Blurred vision
• Mild irritation of the eye
• Discomfort / soreness of the eye

Chalazia may occur in both eyelids simultaneously. If its size is larger, it may interfere with the vision. In presence of infection, it may be red and painful.

We can find recurrence in chalazion. It tends to come back repeatedly. Another chalazion may be formed in the same area or nearby the first chalazion.
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Risk Factors –

• Individuals who have thicker Meibomian gland secretions
• Those who have already had chalazion recently or in the past
• Those who have acne, seborrhea of the eyelids or seborrheic dermatitis
• Chalazion may follow or precede a hordeolum / stye

Diagnosis, prevention tips

Diagnosis of chalazion
Diagnosis of chalazion will be made by an expert physician just by seeing the lump. No special tests are needed to diagnose this condition. Previous history of chalazia will help in diagnosis. An expert like ophthalmologist or optometrist will come in handy in case of suspicion related to diagnosis.

A biopsy may be suggested to be done in case there is suspicion of tumor.
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Differential diagnosis of chalazion
Inflammatory eyelid conditions form the differential diagnosis of chalazion. They are –
Hordeolum / Stye – it is a painful mass at the eyelid margin commonly caused by a bacterial infection of the eyelash follicle.
Blepharitis – is an inflammation of eyelids, at the base of the eyelashes. It is associated with dry eyes, seborrheic dermatitis, rosacea etc conditions. It is a common cause of sore and red eyelids and crusty eyelashes.
Dacryoadenitis and dacryocystitis – is an inflammation of lacrimal / tear glands whereas dacryocystitis is the inflammation of lacrimal sac in the inferior eyelid.
Cellulitis – preseptal (periorbital) and orbital cellulitis are infections of soft tissues of the orbit.
Read – Blepharitis: Inflamed Eyelids Ayurvedic Treatment, Remedies

Other diseases forming differential diagnosis

• Sebaceous gland adenoma
• Sebaceous gland carcinoma
• Sarcoid granuloma
• Foreign body granuloma

Prevention of Chalazion
Those prone to get chalazion should use warm compresses, especially at night. It should be regularly applied over the closed eyelids, 5-10 minutes before going to sleep. This will prevent Meibomian glands from clogging during night.
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Those having seborrhea of the eyelids or recurrent chalazia, warm compresses and regular cleansing of eyelids will help in prevention of chalazion.

Avoiding eye makeup or contact lenses until the chalazion is healed will prevent further discomfort or irritation.

One should not rub the eyes.

One should protect the eyes from dust and air pollution. Sunglasses and safety goggles shall be used as and when needed.
Read – Tarpana Putapaka – Ayurveda Eye Care – Ashtanga Hrudaya Sutrasthana 24

Home Remedies for Chalazia

• Many times the chalazia / chalazion will go away without treatment.
• One should not squeeze or touch the swelling of chalazion.
• Warm compresses shall be applied 3-4 times a day, for 5-10 minutes. One should clean their hands thoroughly before doing any treatment on chalazion. Warm compresses will reduce the swelling to a great extent.
• Gentle massage may be given on the lumps for few minutes, several times a day. One needs to be careful about washing the hands thoroughly before doing it. Over-pressing shall be avoided.
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Treatment, prognosis, Ayurved

Treatment of Chalazion

• When chalazion / chalazia don’t respond to the home remedies in couple of days, one should see a doctor.
• Eye drops / cream may be used as per the instruction of the doctor.
• If the chalazion doesn’t go away with easy home remedies a corticosteroid injection or a surgical intervention may be needed as per the recommendation of the doctor.

Prognosis
As said, the chalazion goes away spontaneously without treatment many times.
Chalazion is not to meddle with the vision.
Large lumps may distort ocular surface. This may cause temporary astigmatism with blurring of vision. The vision disturbances if any will regress back to normal once the chalazion is removed or when its size gets reduced.
It doesn’t become malignant. It is not contagious.
Overall, chalazion has good prognosis.
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Chalazion in Ayurveda
Utsangini is one of the diseases explained in the netra vartma gata rogas (diseases afflicting the eyelids). This disease closely resembles chalazion. According to modern texts, chalazion may appear on the upper or lower lid as against Ayurvedic explanation of Utsangini wherein it is said to manifest only on the lower lid. But due to similarity, utsangini can be compared to chalazion.

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