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A 64-year-old man is evaluated after complaining of a tender area of his right lower eyelid. The patient reports he first noticed the condition approximately 10 days ago. The area has been accompanied by eye tearing but no pus. He denies antecedent trauma and his vision is unaffected. Examination reveals an erythematous papule of the lateral lid. The sclera is of normal appearance and the left eye is unaffected.
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A chalazion, also referred to as a meibomian cyst, presents as a swelling of the eyelid. Meibomian glands are large sebaceous glands that secrete meibum, which is a lipid that contains a substance that plays a key role in maintaining ocular surface health and integrity.1 The secretions are delivered onto the tear meniscus via a duct that opens in proximity to the lid border. Glands in the lower lids have a greater diameter than those in the upper lids. Hormonal and neural factors influence secretion as does mechanical pressure from eye blinking.
Blockage of the glands results in localized swelling and erythema. Chalazion should be differentiated from hordeolum; the latter involves the eyelash follicles and is accompanied by purulent discharge.2
A chalazion usually responds to conservative treatments such as lid massage, warm or even hot compresses, and the application of a lubricating ophthalmologic ointment. Healing may be accompanied by gland dysfunction and microscopic scarring that predispose to recurrence.3 The pathogenesis of Chalazion has been linked to Cutibacterium acnes infection providing a rationale for treatment with doxycycline.4 Chalazions that linger, impair vision, or engender discomfort warrant more aggressive therapy such as intralesional injection of steroids or surgical curettage.5
Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Geisinger Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.
References
1. Knop E, Knop N, Millar T, Obata H, Sullivan DA. The international workshop on meibomian gland dysfunction: report of the subcommittee on anatomy, physiology, and pathophysiology of the meibomian gland. Invest Ophthalmol Vis Sci. 2011;52(4):1938-1978. doi:10.1167/iovs.10-6997c
2. Kapcha A, Law J, Feldman BH, et al. Chalazion. EyeWiki. American Academy of Opthalmology. April 30, 2023. Accessed July 17, 2023. https://eyewiki.aao.org/Chalazion
3. Li J, Li D, Zhou N, Qi M, Luo Y, Wang Y. Effects of chalazion and its treatments on the meibomian glands: a nonrandomized, prospective observation clinical study. BMC Ophthalmol. 2020;20(1):278. doi:10.1186/s12886-020-01557-z
4. Suzuki T, Katsuki N, Tsutsumi R, et al. Reconsidering the pathogenesis of chalazion. Ocul Surf. 2022;24:31-33. doi:10.1016/j.jtos.2021.12.010
5. Jordan GA, Beier K. Chalazion. In: StatPearls [Internet]. Updated August 1, 2022. Accessed July 17, 2023. StatPearls Publishing; 2023.
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