What a chalazion is

The eyelids contain rows of meibomian glands that release oil into the tear film. When a gland opening becomes blocked, the oil backs up, irritates the surrounding tissue and forms a lump called a chalazion. It often starts as a tender, red swelling and then settles into a firm, painless bump within the eyelid.

Chalazia are common at any age. They are more likely in people with blepharitis (inflamed eyelid margins), rosacea or oily skin, and some people get them repeatedly.

Chalazion or stye?

A stye (hordeolum) is an acute infection of a gland at the lash line or within the lid. It is usually painful, red and may come to a head over a few days. A chalazion is a blocked gland with inflammation rather than infection, and tends to be firmer, deeper and less painful once the early phase passes. The two can overlap: a stye that does not fully drain sometimes leaves a chalazion behind.

Conservative measures first

Most chalazia improve with simple, consistent care at home:

  • Warm compresses held against the closed eyelid for about ten minutes, several times a day, to soften the trapped oil. Reheat the compress as it cools, and make sure it is warm rather than hot.
  • Gentle massage of the eyelid towards the lash line after each compress.
  • Lid hygiene with a gentle cleanser along the lash line to keep the gland openings clear.

These measures can take several weeks to work and are worth continuing even if surgery is later needed. Antibiotics are not usually required for a chalazion unless there are signs of infection. Avoid squeezing the lump.

When surgery enters the picture

Surgery is considered when a chalazion:

  • persists despite adequate conservative treatment over weeks to months;
  • is large enough to blur vision by pressing on the eye, or to cause discomfort;
  • recurs repeatedly in the same spot; or
  • is cosmetically bothersome and unlikely to resolve on its own.

In some cases, a steroid injection into the lump is an alternative to removal. Your surgeon will discuss which option suits the size and position of your chalazion.

Why persistent lumps need reassessment

Almost all chalazia are benign. Rarely, other eyelid conditions, including some skin cancers of the eyelid glands, can look like a chalazion. Warning signs include a lump that keeps returning in exactly the same place, loss of lashes over the lump, ulceration, bleeding or an unusual appearance. For this reason, tissue removed from a recurrent or atypical lump is often sent for laboratory examination as a routine precaution. Our article on eyelid cysts, nodules and skin tags covers other common lumps.

What the procedure involves

Chalazion removal, often called incision and curettage, is a minor procedure performed under local freezing. Most chalazia are approached from the inner surface of the eyelid, so there is no visible scar on the skin. A small clamp steadies the eyelid, a tiny incision opens the chalazion, and its contents are cleared. Occasionally, a lump close to the skin surface is removed through a small skin incision that is closed with fine stitches.

The procedure usually takes around fifteen to twenty minutes. Children may need a different approach to anaesthesia, which your surgeon will explain.

Recovery and aftercare

Afterwards, the eye may be covered with a pad for a few hours. Mild swelling, bruising and a little blood-tinged tearing are common for the first day or two. Antibiotic ointment is often prescribed for a few days, and warm compresses are usually restarted after the first day or two to help the area settle.

Most people return to normal activities the next day. It can take a few weeks for any remaining firmness to disappear completely.

Reducing the chance of another chalazion

Because chalazia stem from blocked glands, keeping the eyelid margins healthy reduces the chance of recurrence. Regular warm compresses and lid hygiene help, as does treating blepharitis, rosacea or dry eye when present. Removing eye make-up fully each night and replacing old make-up are also worthwhile.

Questions to ask at your consultation

  • Has my chalazion had enough conservative treatment, or is surgery the next step?
  • Would a steroid injection or removal suit this lump better?
  • Will the procedure be done from inside the eyelid or through the skin?
  • Will the tissue be sent for examination?
  • What can I do to prevent another chalazion?