Synonyms in a broader sense
Medical: Chalazion
Definition Hail Grain
A hailstone (chalazion) is a chronic, i.e. permanent, inflammation of a Meibom gland. Meibom glands are located on the inside of the eyelid. Their secretion provides the fat layer of the tear film.
These glands are responsible for the formation of sebum, which serves to build up the fat layer. This disease is benign and harmless throughout! In the picture you can see very well the painless thickening on the upper limb, which is a hailstone. We would like to thank Mr. K. B. for providing this picture ! We are also happy to take pictures of other of our readers, which are an added value of our site through their pictures.
What is the difference between hailstone and barley grain?
Both the hailstone and the barley grain appear as red, swollen nodules on the eyelid. But there are a few differences. A hailstone usually occurs more often in adults and less often in infants or children.
A barleycorn can occur equally frequently at any age. The development of the hailstone and the barley grain are different. A barleycorn can develop from a bacterial inflammation.
Instead, a hailstone results from a blockage in the excretory duct of the sebaceous gland on the eyelid and is a chronic inflammation with nodular cell accumulations. A barleycorn is therefore usually caused by bacteria, a hailstone is not. A barleycorn can result in a blockage of the sebaceous gland duct and thus a hailstone.
Another difference is that a barleycorn is painful, whereas a hailstone is usually not painful. A recurring barleycorn can indicate diabetes mellitus. A hailstone can also be associated with a metabolic disease such as diabetes mellitus.
It remains questionable whether this is the case with hailstones that have developed from a barleycorn. Both hailstones and barley grains are disturbing but harmless and usually disappear spontaneously. However, in comparison, a barleycorn usually recedes faster than a hailstone.
In both cases, heat has a soothing effect and sometimes surgery is recommended. This rough knot develops very slowly and is completely painless. Apart from the cosmetic impairment there are no complaints.
Sometimes the affected persons also report an unpleasant feeling of pressure. However, conjunctival involvement is rare. The lump is usually located just below the edge of the eyelid and can range in size from grape seed to hazelnut seed.
It cannot be moved under the skin. Hailstones are almost exclusively observed in adults. The ophthalmologist will first examine the eyelid region with the slit lamp.
In order to be able to assess the eyelids from the inside as well as from the outside, the eyelids must be ectropionated. Ectropionization means to fold the eyelid down so that the inside is facing outwards. The differential diagnosis (“Which other disease is possible?”)
is a barleycorn, which is very sensitive to pain. A rare cancer of the meibomian glands (sebaceous gland carcinoma) must also be excluded. This is a tumor which, if discovered too late, can even be fatal.
Also a rare cancer of the Meibom glands (sebaceous gland carcinoma) must be excluded. This is a tumor which, if discovered too late, can even be fatal. In most cases, hailstones are harmless and do not require any special treatment, as they often regress by themselves within a few weeks.
Especially small hailstones, which cause no or only slight discomfort, regress without therapy. The measure of first choice is daily eyelid hygiene and care. Often the aesthetic aspect is the main focus of the desire for treatment.
Since a hailstone is often accompanied by an inflammation that causes pain or discomfort, anti-inflammatory or antibiotic eye drops or eye ointments can be used to alleviate redness and swelling. In addition, gentle heat treatment, such as using a red light lamp (two to three times a day for about ten minutes), can relieve the congestion of secretions and accelerate the healing process. When using red light, it is important to ensure that the eyes are well closed and that the distance to the lamp is maintained.
A similar effect can be achieved with clean, warm and moist compresses, which are applied to the closed eyelids for a few minutes.Regular massages of the hailstone, in which one massages with clean fingers in circular movements towards the eyelid, can also help to treat the hailstone. Tablets are not helpful in most cases. Removal of the hailstone should always be left to a doctor.
When removing by pure “squeezing” of the hailstone, the pustule with all its bacteria can be pressed into the bloodstream behind it. Via this the bacteria then migrate into the head and neck area and can cause serious complications such as meningitis or neuritis. During the surgical opening of the hailstone, a small incision is made at the front.
Through this the pus secretion can easily drain off without additional pressure. However, no scarring is expected: since the incision is only in the millimeter range, the wound appears more like a mosquito bite after healing and is no longer visible after a few days. During removal, in addition to the surgical treatment, an antibiotic ointment is usually prescribed, or – in severe cases – systemic antibiotics.
This prevents the pathogens from spreading in the body. In principle, removal can be carried out by any family doctor or dermatologist, as it is a very minor procedure. The procedure, including healing, is completed in 1-2 weeks.
However, it does not protect against recurrence, so that a recurrence cannot be ruled out. A short operation under local anesthesia can be useful if the hailstone does not recede of its own accord under conservative therapy or causes very strong pain or discomfort. The hailstone is opened with a small incision and the congested and inflamed tissue is removed.
Prior to the operation, a basic ophthalmological examination is usually performed, so that the respective findings on the eyelid can be examined and causes other than a hailstone for the swelling can be excluded. The operation is performed under local anesthesia, which is injected under the skin. Then the eyelid is held in place with a special eyelid holder (a so-called chalazion clamp) and the eyelid is folded over (ectopic).
The eyelid skin must be opened with a tiny incision. This can be done either on the outside or inside of the eyelid (depending on the findings). If the eyelid skin is opened from the outside, the wound is usually closed with one or two fine stitches, which can be removed after one week.
An incision on the inside of the eyelid usually does not require sutures. After opening the hailstone through the incision, the contents of the hardening can be scraped out with a small, spoon-like instrument. It is also necessary to remove the capsule of the hailstone as much as possible to prevent a renewed accumulation of secretion.
Following the very short (about three minutes) operation, an antibiotic ointment is applied to the eyelid and an eye bandage is applied. This can usually be removed on the first day after the operation. After the minor operation, there is usually no need to reckon with long-term impairment.
Normally, the patient can resume his or her usual activities the very next day. The eyelid may still be slightly swollen or reddened for a few days. The operation of a hailstone can be performed in most cases without major complications.
As with any surgical procedure, there is a risk of bleeding or secondary bleeding and infection. Complications such as an injury to the eye, nerve damage or a distortion of the eyelid due to scarring cannot be completely ruled out, but are very rare surgical complications. After surgical removal, the tissue is examined under a microscope.
This is necessary because in rare cases a malignant (malignant) growth may be present instead of a hailstone. By examining the tissue, a possibly causal tumor in the eye can be reliably excluded. If the tissue examination reveals a different finding, further treatment measures may be necessary.
As a rule, hailstones regress by themselves. However, if this is not the case, treatment with ointments can be used as a supporting measure. However, an ointment is only useful in case of an acute inflammation or bacterial colonization.
If the hailstone has already burst open, a wound and healing ointment such as Bepanthen® can be used as a support. In this case, it is important to use a sterile cover to prevent a new inflammation.Bacterial inflammation is best combated with ointments containing antibiotics, e.g. Refobacin®. However, ointments containing cortisone also combat inflammation and allow the hailstones to subside more quickly.
The type and duration of application is determined by the doctor’s recommendation. Ointments containing cortisone have the disadvantage of damaging the skin in the long term, making it leathery and thin. Although this effect is only locally limited to the eyelid, and is reversible, it should still be mentioned.
Too frequent use of antibiotics can result in antibiotic resistance. Under no circumstances, however, should the hailstone be expressed, as the pus it contains can enter the brain via the bloodstream, where it can trigger bacterial colonization of the meninges (meningitis). For some people affected, homeopathic treatment, in addition to other methods, has a supportive effect.
Here, the treatment should be carried out individually and by a specialist with extensive knowledge. For example, Myristica C9 is used. If pus is present, it can cause it to be emptied more quickly and promotes faster healing.
Pyrogenium C7 and C9 are also used. It can have a supportive effect in that the sebaceous node dissolves. It can also prevent pus formation.
Hepar sulfuris C15 can be used to minimize increased formation of swelling and pus. In addition, Belladonna C5 can be used to generally relieve pain and swelling. Silicea C4 can also be used to generally stimulate wound healing.
For example, a red light lamp can be used to support the healing process. The dry heat of the lamp can reduce inflammatory processes and support the drainage of secretions. When using the red light lamp, the eyes should be closed and remain closed.
Warm, moist cloths or washcloths can also be placed on the closed eyes for relief. The warmth causes the pores of the eyelid to open better and the sebaceous nodule to break down better. It is not advisable to use self-produced solutions or preparations, as these are not sterile.
The cause of a hailstone is a chronic inflammation of a sebaceous gland in the eyelid area. If the hailstone lies on the edge of the eyelid near the eyelashes, a so-called Zeis gland is affected. A larger lump that lies further away from the edge of the eyelid is usually caused by the Meibom glands.
These glands secrete an oily fluid that mixes with the tear fluid secreted by the lacrimal glands. The sebaceous fluid ensures that the tear fluid does not evaporate too quickly. In the vernacular, the dried up, tallowy secretion of the Zeis or Meibom glands is also called “sleeping sand”.
If these glands are chronically inflamed, one speaks of a hailstone (chalazion). The chronic, mostly painless inflammation usually leads to a blockage of the glandular ducts. The difference is an acute inflammation of the Meibom glands with bacteria (mostly staphylococci), which leads to a barleycorn.
A hailstone is formed when the ducts of a gland are blocked, as this leads to a congestion of secretions and inflammation of the adjacent tissue. The development of a hailstone is favored, for example, by a chronic inflammation of the eyelid margin (blepharitis). Blepharitis often occurs together with an inflammation of the conjunctiva (conjunctivitis) and can be a consequence of general skin diseases.
Inflammation of the eyelid margin manifests itself by clotted eyelids and eyelashes (especially after sleep) and a foreign body sensation. A red, burning or itchy eyelid margin is typical. In this disease, the meibomian glands produce too much sebum (meibomitis), which can lead to blockage of the excretory duct and the formation of a hailstone.
Hailstones are more common in adults than hailstones in children. In addition, hailstones can be caused by skin diseases associated with a malfunction of the meibomian glands. Skin diseases such as acne vulgaris or acne rosacea are also associated with increased sebum production by the glands.
Metabolic diseases such as diabetes mellitus can also be the cause of hailstones. In very rare cases, a tumor of the eyelid can also be responsible for the fact that a glandular duct is displaced and a secretion congestion occurs, which triggers a hailstone. There is no way to counteract or prevent the formation of a hailstone.
Both the formation of a hailstone and its healing usually takes a few weeks.Some affected persons can be supported by soothing home remedies or, if necessary, homeopathic treatment and the course can be easily accelerated. Touching the hailstone or attempts to express it can prolong the course and possibly cause complications. In rare cases, vision problems or conjunctivitis may occur.
Some patience is required when treating a hailstone, as the regression process often takes several weeks. If there is no improvement, a treatment of the hailstone is necessary, because after a longer period of time skin thinning can occur due to a larger hailstone, which can turn reddish. In addition, the longer a hailstone is left in the eyelid, the greater the risk that vision will be impaired by the permanent pressure on the cornea.
Therefore, in some cases surgery may be necessary. Hailstones can occur repeatedly. In this case, it is advisable to have a doctor determine the cause of the repeated occurrence, since hailstones can also be a sign of other serious diseases.
The prognosis is good. However, there may be recurrences, i.e. the ducts of the Meibom glands may become blocked again. Here the cause, for example diabetes, should be clarified.
A hailstone occurs when a sebaceous gland on the eyelid becomes chronically inflamed. This is usually caused by bacteria. However, a hailstone, just like a barley grain, is not contagious, since the pathogens are located in a closed room, and even if the hailstone would open by itself, the pathogens are usually not contagious.
The hailstone is a knotty, coarse hardening, which can be pressure painful on the one hand, but can also trigger a foreign body feeling during blinking. The diagnosis is usually made by a general practitioner or ophthalmologist through a gaze diagnosis. Hailstones usually heal by themselves.
In some cases it may be necessary to perform a minor operation. Here the hailstone is pricked with a small, thin needle. The contents then emerge.
As a prophylactic measure, the hailstone can be treated with an antibiotic ointment or antibiotic eye drops. As a rule, the hailstone does not form pus because it is not caused by a bacterial, purulent inflammation. This is different with the barleycorn.
In some cases a barleycorn can turn into a hailstone. Thereby, in the “transition” an accumulation of pus can develop in the hailstone. This can be minimized by homeopathic remedies for some people affected or, if necessary, make it easier to empty the pus.
If the sebaceous glands on the eyelid, the so-called Meibom glands, produce more sebum, the excretory duct can be blocked. Such a blockage of the excretory duct at the edge of the eyelid causes the body’s own enzymes and bacteria to break down components in the excretory duct. These degradation products are then transported into surrounding tissue and cause a granulomatous inflammation of the sebaceous gland on the eyelid.
This leads to an immune reaction on the eyelid. This leads to nodular cell accumulations. These can be seen as a bulge just below the edge of the eyelid.
A knot the size of a grape seed to hazelnut seed is felt. Since this lies in the cartilage of the eyelid, it cannot be moved. The hailstone is usually painless, since the immune response of the eyelid is not caused by bacterial inflammation, but by the body’s own degradation products.
A hailstone occurs less frequently in small children than in adults. It is usually harmless and does not necessarily disturb small children. However, it is also possible that infants touch it repeatedly with their hands and thus slow down the healing process.
Treatment with a disinfectant ointment is recommended rather than surgery. Even if the hailstone only slowly becomes smaller. Surgery is sometimes recommended for adults. However, it is not recommended for small children at first, as this operation could cause great stress for the children.