Meibomian cyst (chalazion)
Exam Tips
- Key distinction: chalazion is usually chronic and painless; stye is acute and painful with infective signs.
- OSCE red flags needing urgent action: painful ophthalmoplegia, reduced vision/diplopia, proptosis, fever, severe headache (think orbital cellulitis).
- Recurrent lesion in the same location in an older patient is sebaceous carcinoma until proven otherwise; arrange urgent ophthalmology/2WW assessment.
- In children, always consider refractive impact: a large upper-lid chalazion can induce astigmatism and amblyopia risk.
- Image reference for revision: compare a typical tarsal chalazion photo with hordeolum and sebaceous carcinoma images in your ophthalmology atlas eyelid-lesions chapter.
Definition
A meibomian cyst (chalazion) is a chronic, non-infective lipogranulomatous inflammation of the eyelid caused by blockage of a meibomian gland duct in the tarsal plate. Retained lipid leaks into surrounding tissue and triggers a granulomatous reaction, so the lesion is usually a slowly enlarging, firm, often painless eyelid nodule.
Pathophysiology
Obstruction of a meibomian gland prevents normal lipid (meibum) secretion into the tear film. The gland distends and may rupture, releasing lipid into eyelid soft tissue; this provokes a sterile granulomatous inflammatory response (lipogranuloma), which explains why tenderness is often mild and short-lived early on, then settles. Upper lid involvement is more common because the upper lid contains more meibomian glands. Large lesions can mechanically distort the cornea, inducing astigmatism and visual blur.
Risk Factors
- Previous or concurrent internal hordeolum (stye)
- Chronic blepharitis / meibomian gland dysfunction
- Rosacea
- Seborrhoeic dermatitis
- Diabetes mellitus
- Hypercholesterolaemia
- Pregnancy
- Poor lid hygiene or recurrent eyelid irritation (for example cosmetics/contact lens-related irritation)
Clinical Features
Symptoms
- Slowly developing eyelid lump over weeks
- Usually painless; may be mildly tender in early inflammatory phase
- Cosmetic concern or lid heaviness
- Blurred vision if large lesion causes corneal distortion/astigmatism
- Occasional watery or irritated eye from mechanical rubbing
Signs
- Well-defined, firm, usually non-tender subcutaneous tarsal nodule (often about 2-8 mm)
- More often in upper lid, typically away from lash line
- Overlying skin usually normal; erythema often absent
- Possible mechanical ptosis or impaired lid closure if large
- On lid eversion, conjunctival granulomatous change may be visible
- May be single or multiple lesions, unilateral or bilateral
Investigations
Management
Lifestyle Modifications
- Explain benign course: many resolve over weeks to months
- Warm compress to closed eyelid for 10-15 minutes, 3-5 times daily
- After warming, gentle lid massage toward lash line (upper lid downward, lower lid upward)
- Lid hygiene and management of blepharitis/rosacea/seborrhoeic dermatitis to reduce recurrence
- Avoid squeezing or attempting self-incision; safety-net for red-flag infection or visual symptoms
Pharmacological Treatment
Analgesia (if discomfort)
- Paracetamol 500 mg-1 g orally every 4-6 hours when required (maximum 4 g/day)
- Ibuprofen 200-400 mg orally up to three times daily with food (maximum 1.2 g/day OTC; up to 2.4 g/day only on medical advice)
Not curative for chalazion but can help pain. Avoid/limit NSAIDs in peptic ulcer disease, significant renal impairment, heart failure, NSAID-sensitive asthma, or anticoagulant use.
Antimicrobials (only if secondary infection, not routine chalazion treatment)
- Chloramphenicol 0.5% eye drops: 1 drop every 2 hours for 48 hours, then every 4 hours during waking hours, usually for 5 days total
- Chloramphenicol 1% eye ointment: apply 3-4 times daily (or at night with drops)
Routine topical/oral antibiotics are not recommended for uncomplicated chalazion. Use only when there is clinical bacterial blepharoconjunctivitis or secondary infection. Avoid chloramphenicol in people with personal/family history of blood dyscrasia; stop and review urgently if systemic illness or worsening orbital features.
Specialist anti-inflammatory injection
- Intralesional triamcinolone acetonide (for selected persistent lesions under ophthalmology care)
Performed by experienced clinicians only. Safety concerns include skin depigmentation, fat atrophy, raised intraocular pressure, and rare globe injury if technique is poor.
Surgical / Interventional
- Incision and curettage by ophthalmology for persistent, large, functionally significant, or cosmetically troubling lesions
- Urgent same-day hospital referral if periorbital/orbital cellulitis is suspected
- Urgent suspected-cancer-pathway referral for atypical features or recurrent same-site lesion, especially in older adults
Complications
- Mechanical ptosis and incomplete lid closure
- Corneal compression causing induced astigmatism and visual disturbance
- Amblyopia risk in children if astigmatism is prolonged and untreated
- Chronic overlying skin/lid changes in persistent lesions
- Secondary infection progressing to preseptal (periorbital) cellulitis, and rarely orbital cellulitis
Prognosis
Most chalazia resolve spontaneously or with conservative measures, though resolution may take several weeks to months. Recurrence is common when underlying lid disease (for example blepharitis or rosacea) is not controlled. Persistent or recurrent same-site lesions require reassessment to exclude malignancy.
Sources & References
✅NICE Guidelines(1)
- Meibomian cyst (chalazion)[overview]
📖Textbook References(1)
- [Williams, Bailey and Love's Short Practice of Surgery] Norman Williams, Christopher Bulstrode, P Ronan O'Connell - Bailey & Love's Short Practice of Surgery 26E (2013, CRC Press) - libgen.li.pdf(pp. 650)[context]