Symptoms
A chalazion (Greek chalazion, χαλαζιον) is a painless lipogranulomatous swelling of a meibomian gland in the eyelid, about the size of a pea. The nodule is located just below or above the edge of the eyelid and enlarges over several weeks (Figure, click to enlarge). It can cause eye irritation, an uncomfortable foreign body sensation and dry eyes. Larger nodules cause visual disturbances such as blurred vision and drooping of the eyelids. Chalazia are cosmetically bothersome. © Lucille Solomon, 2011 http://www.lucille-solomon.com
Causes
The cause of the condition is an obstruction of the excretory duct of the meibomian gland. Oily secretions are retained, leading to an inflammatory reaction and the formation of a nodule. Risk factors for developing a hailstone include eyelid margin inflammation, which is often caused by seborrhea, rosacea, or infection.
Diagnosis
Diagnosis is made by medical treatment. A painful and red nodule on the edge of the eyelid indicates a stye; swollen, inflamed, red, and crusted eyelids indicate eyelid rim inflammation. Other possible differential diagnoses include sebaceous gland carcinoma and dacryocystitis. It is important to note when making a diagnosis that similar symptoms can also be caused by malignant neoplasms (!)
Treatment
A hailstone may resolve on its own over the course of weeks or months. However, the course is often chronic-recurrent. Daily eyelid hygiene and care is considered the first-line measure:
- Apply body-warm compresses in the morning and evening for about 3-10 minutes to liquefy the material in the lump. For this purpose, for example, a washcloth moistened with warm water can be used.
- Regularly massage the hailstone with a clean fingertip in the direction of the eyelid.
- In the case of concomitant inflammation of the limb of the eyelid, good eyelid margin hygiene is recommended, for example, with a wet wipe (see there).
Less than half of all patients can be freed from the hailstone with conservative treatment. Second-line measures include minor surgery (incision and curettage) or local corticosteroid injection with triamcinolone acetonide. Antibiotics are used only for concomitant infections. Underlying conditions such as rosacea are treated separately.
