A 23yo German female patient presented to the clinic with a history of acute swelling of her R eyelid. She also complained of sensitivity to light, increased tearing and heaviness of her lid. A provisional diagnosis of chalazion was made as the lid was acutely inflamed and infected, but unlike a stye, the lesion was positioned inside the lid rather than on the lid margin. The patient said that her GP had given her chloramphenicol drops and some Augmentin but the lesion continued to grow in size.
On examination there was evidence of an infected cyst (meibomian gland lipogranuloma) caused by inflammation of a blocked meibomian gland on the upper eyelid. Usually my patients with chalazion tend to undergo triamcinolone application in chalazion or surgical procedure that includes incision, excochleation and excision of the capsule of chalazion,
Treatment (Excisional Surgery)
We lifted the eyelid to access the back of its surface and made an incision of 3-4 mm just on top of the chalazion. The lump was then removed, and pressure is applied for a few minutes to stop bleeding. The patient did not require any stitches, as the cut was at the back of the eyelid and could not be seen. Although chalazia are rarely dangerous, it is common to send the chalazion or part of it to a laboratory to screen for cancer
There is some difference of opinion towards patients with chalazion whether they first should undergo a triamcinolone injection in chalazion or a surgical procedure that includes incision, and excision of the capsule of chalazion. Some authors have found that chalazion treatment with triamcinolone application directly in the lesion was to be more comfortable for patients, took less time to treat and needed no additional topical antimicrobial therapy (2). Subcutaneous injection of the steroid triamcinolone acetonide in primary and recurrent chalazion appears to be a simple and efficacious therapeutic option for chalazion (3). The chalazion may be surgically removed in two ways, depending on the size of cyst. Relatively small chalazia are removed through a small cut at the back of the eyelid. Larger chalazia are removed through an incision in front of the eyelid as they push on the skin of the eyelid. The incision is not usually larger than 3 mm and it is made on top of the chalazion. The lump is removed and then pressure is applied on the incision to prevent oozing (3). The incision is closed with very fine stitches, usually removed within a week after the surgery has been performed.
Preferable incise the chalazion from the inside of the eyelid
1. Coll Antropol. 2013 Apr;37 Suppl 1:247-50. Chalazion management--surgical treatment versus triamcinolon application. Biuk D1, Matić S, Barać J, Vuković MJ, Biuk E, Matić M.
2. Intralesional triamcinolone acetonide injection for chalazion. Pavicić-Astalos J, Iveković R, Knezević T, Krolo I, Novak-Laus K, Tedeschi-Reiner E, Rotim K, Mandić K, Susić N. Acta Clin Croat. 2010 Mar; 49(1):43-8.
3. http://www.netdoctor.co.uk/surgical-procedures/removal-of-chalazion.htm N Engl J Med. 2001 Mar 29;344(13):975-83. Cutaneous squamous-cell carcinoma. Alam M1, Ratner D.