A chalazion, also known as a hailstone, is a cyst in the eyelid. This is caused by inflammation of a blocked gland on the upper eyelid. A chalazion differs from a stye (hordeola) in that it is a subacute and usually painless nodule.
What is a hailstone?
A hailstone on the eye. The skin is red, swollen, and painful. The glands affected by a chalazion are the meibomian or eyelid glands located in the eyelid. There are approximately between 30 to 40 of these sebaceous glands in each of the upper and lower eyelids. They produce a thick fluid that is contained in the tear film of the eye and lubricates the surface of the eye. A chalazion is the result of a swollen sebaceous gland in the eyelid, caused by chronic inflammation after blockage of the gland duct. Although the cyst tends to grow larger than a stye, it is painless after swelling and is considered harmless. Adult people are more likely to suffer from a chalazion than children. Recurrent chalazions in the same location can sometimes be a symptom of sebaceous gland carcinoma, a rare type of cancer.
Causes
A chalazion is the result of an inflammatory process. The narrow opening through which a meibomian gland secretes its secretions may become blocked as a result of narrowing of the opening or hardening of the sebaceous gland fluid near the opening. The backwater causes the walls of the gland and the secreting secretion to thicken within the eyelid itself. This leads to inflammation both within the gland and on the eyelid, and eventually to the formation of a cyst (chalazion). One possible cause of a chalazion is incomplete removal of eye makeup, which causes oil from the cosmetic product to collect in the glands. Inflammation of the eyelid margin (blepharitis) as a result of the overproduction of sebum due to meibomitis or inflammatory skin diseases such as acne vulgaris or acne rosacea can also cause a chalazion.
Symptoms, complaints and signs
A chalazion is a clearly visible lump on the eyelid. It outwardly resembles a stye, but unlike the latter, it is usually not painful. Unlike the latter, its course is also not acute, but it develops gradually over several weeks and grows slowly. Characteristic of the chalazion is that it can be moved. The chalazion is normally about the size of a hailstone, which is why it is called that. In some cases, much smaller chalazions also occur. The simultaneous presence of several hailstones are uncommon. Usually, a chalazion does not cause any pain, but it can occur in conjunction with an uncomfortable feeling of pressure on the eye, which can be caused by friction. This can sometimes cause irritation of the eye and inflammation of the conjunctiva (conjunctivitis). The affected eye is noticeably reddened. There may be increased sensitivity to light and increased tearing. In rare cases, hailstones can also be so large that they impair vision. Without treatment, the hailstone usually disappears completely within a few months or years.
Diagnosis and course
Symptoms of developing a chalazion include swelling of the eyelid associated with tenderness, sensitivity to light, or perceived heaviness of the eyelid. A bump on the eyelid appears clearly visible. A chalazion usually occurs in the upper eyelid. Smaller chalazions disappear over time, while larger chalazions become more permanent or even increase in size. Enlarged chalazions can increase the pressure of the eyeball and cause visual disturbances. In addition, there is a risk of secondary infection of the blocked gland, which in turn causes irritation, pain, and inflammation. For a relatively clear diagnosis, the eyes are examined with regard to visual function and field of vision. To reliably distinguish a hailstone from a stye, the attending physician will also fold over the affected eyelid to examine the inside. In addition, palpation will check for displacement of the chalazion.
Complications
A chalazion is usually not much larger than a grain of rice and only needs to be treated with eye drops or ointment if it is more inflamed. Very often, it regresses on its own without complications, requiring no further action. In some cases, however, it may swell.Then the hailstone endangers the ability to see and surgery becomes necessary to remove the tissue nodule. Larger hailstones otherwise persist for a long time without swelling. Complications with the conjunctiva may also occur. Surgery is performed only if the chalazion causes great pain or is larger than normal. This is because rare complications are also possible. While most of the patients have no more discomfort already a few days later, postoperative bleeding and infections cannot be excluded, as with any surgery. Damage to the optic nerve or the eye itself during surgery is also possible. Sometimes a scar is also left behind, causing the eyelid to become distorted. Normally, no traces of the surgery remain on the eye. Recurrent inflammation may indicate underlying diseases such as diabetes mellitus or other metabolic diseases and must be investigated for these.
When should you see a doctor?
Normally, a hailstone does not require medical treatment. It is a harmless inflammation of the eye gland that heals on its own after a few days. If the symptoms have not subsided after a week at the latest, a visit to the family doctor or ophthalmologist is indicated. Accompanying symptoms such as severe pain, pus formation or visual disturbances also require medical treatment in order to avoid the development of serious complications. If another hailstone forms after treatment, a comprehensive examination is required in any case. It is possible that the complaints are based on an allergy or a serious disease, which must be diagnosed and treated. In individual cases, recurrent inflammation may develop into a eyelid tumor. Therefore, recurring complaints should be examined by a specialist. Patients at risk, such as people with chronic eye diseases, allergy sufferers, children, the elderly and pregnant women, are best advised to have a hailstone clarified immediately by their family doctor. Other contacts are the ophthalmologist, the alternative practitioner and, in case of severe symptoms, the medical emergency service.
Treatment and therapy
Treatment will initially be without intervention. For this purpose, a hot compress can be pressed onto the affected region or lightly massaged to get the glandular secretions flowing again. Likewise, homeopathic remedies are excellent for treatment. If antibiotic eye drops or eye ointment such as chloramphenicol or fusidic acid also do not clear up a chalazion, surgery is recommended. Removal of a chalazion is an outpatient procedure that usually takes no more than 15 minutes. Due to the risk of infection and severe damage to the eyelid, such procedures should only be performed by a physician. The eyelid is numbed with a local anesthetic. A clamp is then placed on the eyelid to securely hold it in place and allow it to be turned over. The doctor will then make an incision of about 3 mm on the inside of the eyelid to scrape out the chalazion. Because scarring of the eyelid can cause vision problems, surgery will only be considered as a last treatment option. Although chalazions are rarely dangerous, it is common to send tissue pieces for biopsy for cancer screening.
Outlook and prognosis
The prognosis of a hailstone is favorable. The small or medium-sized hailstones usually regress completely within a few weeks. No secondary damage or impairment remains. Many patients suffer from the visual blemish caused by a hailstone. The emotional state of the affected person usually improves as the foreign body subsides. With large hailstones, there is a temporary impairment of vision. Since the eyelid cannot be moved as usual, the affected person’s field of vision is severely limited. Many doctors advise surgical intervention in these cases. If the patient decides to have the hailstone surgically removed, he or she is normally considered to be symptom-free afterwards. If no further complications or delays in the healing process occur, the patient is discharged from treatment as healed after a few days. The eyelid can be opened as usual after the wound has healed.Thus, the ability to see is fully restored, since the presence of a hailstone has no influence on the functional capacity of the eyeball or the information processing of the incoming sensory stimuli. Only the field of vision is restricted by the foreign body. If a hailstone develops again in the course of life, the prognosis is also favorable. The course of the disease and treatment options remain unchanged if it recurs.
Prevention
To prevent a hailstone, thorough eye hygiene is recommended. This includes a thorough makeup removal and cleaning of the eyelashes like a meticulous cleaning of needed contact lenses. Basically, a strengthening of the immune system also helps to counteract inflammatory processes.
Aftercare
In most cases, no special or direct measures and options of aftercare are available to the affected person in the case of a chalazion. However, these are also not necessary, since it is a harmless disease, which usually disappears again by itself, without the need to initiate treatment. However, if the chalazion occurs for a longer period of time and does not disappear on its own, an ophthalmologist should be consulted. This may prevent further complications and discomfort, which in the worst case would lead to complete blindness of the affected person. Chalazion can be treated relatively well with eye drops or eye ointment. These medications should be used regularly and in the correct dosage. In case of ambiguity or questions, a doctor should always be consulted. If the chalazion does not disappear by itself through the measures and means of self-help, a doctor should be consulted immediately. The affected eye should be particularly well protected in the case of chalazion. Especially after a surgical procedure, the eyes should be protected particularly well. As a rule, this disease does not reduce the life expectancy of the affected person. Furthermore, no more measures of an aftercare are necessary.
What you can do yourself
A hailstone can be treated very well by a few measures yourself. To loosen the congestion of secretions, it is recommended to apply a warm compress. The warmth widens the pores and causes the secretion to flow away. Disinfectant and anti-inflammatory plant extracts can also be added to the warm water: These include sage, rockrose and chamomile. If the inflammation spreads to the rest of the eye, eye drops can also be used. Antibiotic administration is usually not necessary. Eye drops are commercially available means with hyaluronic acid – these provide long-lasting moisturization – or based on the plant eyebright. Euphrasia – the Latin name – is offered in the form of ampoules or globules. Thus, an internal and external application can take place. The intake of selenium – an anti-inflammatory micronutrient – is also a useful internal support. If the hailstone does not heal and scarring is imminent, it is necessary to consult an ophthalmologist or surgeon. This would remove the chalazion in an outpatient procedure. However, due to the risk of infection, this is the last option for treatment. As a preventive measure, care should always be taken to thoroughly remove eye makeup. Thorough hygiene also concerns used contact lenses. To care for the edges of the eyelids, those affected can resort to completely natural means: olive or coconut oil have a disinfecting and caring effect at the same time.
