Chalazion: Causes, Symptoms & Treatment

What is a chalazion?

A chalazion is a swelling that appears in the middle of the eyelid and usually develops over a few weeks.

Page contents

1. What is a chalazion?
2. What are the symptoms?
3. What causes a chalazion?
4. Is a chalazion common in children?
5. How is it different from a stye?
6. Can a chalazion spread to the other eyelid?
7. Is a chalazion contagious?
8. How is a chalazion treated?
9. How to get rid of a chalazion: warm compresses step by step
10. When is surgery needed?
11. Can a chalazion come back?
12. Chalazion on the upper and lower eyelid: is there a difference?
13. Internal or external chalazion?
14. A chalazion that will not go away or has hardened: what does it mean?
15. How a chalazion is diagnosed in the clinic
16. Chalazion removal: how the minor procedure is done
17. Steroid injection: when is it an option?
18. Common mistakes that slow down healing
19. Prevention: how to reduce the chance of it coming back
20. When to see an ophthalmologist straight away
21. Chalazion during pregnancy and breastfeeding
22. Frequently Asked Questions about Chalazion

What are the symptoms?

The most common symptom is a painless swelling of the eyelid with mild to moderate tenderness, which may come with increased watering, a feeling of heaviness and redness of the conjunctiva. A large chalazion can cause astigmatism because of the pressure it puts on the cornea. A chalazion can appear on either the lower or the upper eyelid.

What causes a chalazion?

A chalazion is caused by a blockage of certain glands called the meibomian glands. These glands sit in a row next to each other, with 40 to 50 in the upper eyelid and 30 to 40 in the lower. Their job is to produce an oily secretion that forms part of the tears, more precisely their outer layer, known as the lipid layer. The better these glands work, the better the whole tear film works, and the less dry the eyes are. When the glands are not working properly, a condition called blepharitis develops, together with mild inflammation. The oily secretion of the meibomian glands then changes consistency and builds up at the gland opening. Things are often complicated by a mite called Demodex, which makes the inflammation worse. The result is frequent blockage of the glands, in other words a chalazion, which in turn makes the inflammation even worse.

Is a chalazion common in children?

Chalazion is particularly common in children of all ages. It can often last for months, and the treatment is the same as for adults. It is important to teach children not to touch their eyes with dirty hands, and with very young children we should clean their hands often ourselves. Eyelid cleansing products such as Ophthalmogen, Naviblef and others can help a great deal with this.

How is it different from a stye?

A stye is a similar condition, with redness and pain right on the edge of the eyelid, and it can develop into a chalazion. It is caused by an acute bacterial infection, most often staphylococcus.

Can a chalazion spread to the other eyelid?

There is usually no infection in a chalazion, so spread to the other eyelid is not common. However, when blepharitis is also present, the eyelids are often colonised by bacteria, which we may unknowingly carry to the other eyelid and infect it. Care is also needed if a secondary infection develops and starts to spread across the whole eyelid, a condition called preseptal (periorbital) cellulitis.

Is a chalazion contagious?

No. A chalazion is not an infection but an inflammation that forms when a meibomian gland in the eyelid becomes blocked. The secretion is trapped and the body reacts by forming a small lump, which is usually painless. It is not passed on through contact, shared towels or make-up.

It is often confused with a stye, which is a bacterial inflammation, usually caused by staphylococcus, and causes pain, redness and sometimes pus. A stye does not spread easily either, but bacteria can be carried on the hands, which is why good hygiene matters.

A chalazion that keeps coming back is usually linked to blepharitis, rosacea or oily skin, not to catching it from someone else. Daily eyelid hygiene, avoiding rubbing the eyes, and regularly cleaning make-up and brushes all reduce recurrences.

How is a chalazion treated?

Chalazion treatment starts with a conservative approach. The first step is a combination of an antibiotic and a corticosteroid in the form of drops or, even better, ointment. Treatment works better when patients also use warm compresses, such as Ophthalmogen EYE10 (self-heating masks), which soften the oily secretion of the glands and help them open naturally. If the chalazion keeps growing despite treatment, a steroid injection is an option to avoid surgical removal. Oral antibiotics are rarely needed, and only if the chalazion becomes infected and the infection starts to spread across the whole eyelid. Eyelid massage with Ophthalmogen gel can also help a great deal, both in opening the glands naturally and in controlling Demodex mites and bacteria on the eyelids.

How to get rid of a chalazion: warm compresses step by step

Most chalazia go away without a procedure within a few weeks, as long as warm compresses are done correctly and consistently. The heat liquefies the thick secretion of the blocked gland and helps it drain.

1. Wash your hands well and remove contact lenses and make-up.
2. Soak a clean cloth in warm water, as warm as the skin on your wrist can comfortably tolerate, and wring it out.
3. Place it on the closed eyelid for 5-10 minutes. When it cools down, soak it again so the temperature stays steady.
4. Straight afterwards, gently massage with a clean finger, moving towards the base of the eyelashes, for about half a minute.
5. Clean the edge of the eyelid with a dedicated wipe or eyelid hygiene solution.
6. Repeat 3-4 times a day for 2-4 weeks.

Do not squeeze the chalazion or try to “pop” it, as this can inflame the surrounding tissue. Heated eyelid masks, which keep a steady temperature, are a practical alternative. If the chalazion has not shrunk after 3-4 weeks, is getting bigger, is painful or affects your vision, it needs to be assessed by an ophthalmologist.

When is surgery needed?

Surgery is the last resort, when everything else has failed, and also when the chalazion is a significant cosmetic concern for the patient. A chalazion can stay in this form for months. As a general rule, we try to avoid operating on the eyelids, because every incision increases the risk of the eyelid turning outwards or inwards in the future.

The procedure itself is fairly simple and is done under local anaesthetic. The best place for removal is an operating theatre, but it can also be done outside one, as a fully sterile environment is not essential. There are two ways to remove a chalazion, depending on its size. For a small chalazion, a small incision is made on the inner side of the eyelid after it has been turned over, as we do during an examination. The opening is made right at the top of the chalazion, is usually no more than 3 millimetres long, and the inside is then cleaned out. For a larger chalazion, where there is more pressure on the skin on the outer surface, the incision may be made on the outer side of the eyelid. Once the area has been cleaned, a light pressure dressing is applied for a few hours and the patient goes home.

Finally, the cost of chalazion removal is particularly low. For more information about prices, please contact the ophthalmologist.

Can a chalazion come back?

Any of the meibomian glands can become blocked and eventually form a new chalazion. The more blepharitis someone has, the greater the chance of a chalazion appearing again in the future.

Chalazion on the upper and lower eyelid: is there a difference?

A chalazion can appear on either the upper or the lower eyelid, because there are meibomian glands in both. The upper eyelid has more and longer glands, so chalazia are more common there and sometimes larger. A chalazion on the upper eyelid that grows quite large can press on the cornea and cause temporary astigmatism, leading to blurred or “distorted” vision that corrects itself once the swelling goes down.

On the lower eyelid a chalazion is usually easier to see, and it often leans towards the inner side, becoming visible when the eyelid is gently pulled down. Treatment is the same in both positions. What changes is the technique if removal is needed, which the ophthalmologist chooses according to the location and size.

Internal or external chalazion?

Most chalazia grow towards the inner surface of the eyelid, the side that rests against the eye. When the doctor turns the eyelid over, a reddish or yellowish area can be seen. This internal chalazion often causes a foreign body sensation, as if there were “something in the eye”, and irritation when blinking.

An external chalazion pushes towards the skin and appears as a round, firm lump. It is not usually painful, but it is a cosmetic nuisance. The same rule applies in both cases: do not squeeze it or try to “pop” it, because the irritation makes the inflammation more persistent and increases the chance of a secondary infection.

A chalazion that will not go away or has hardened: what does it mean?

If a chalazion lasts more than four to six weeks despite regular warm compresses, its contents have probably become “organised”. The body forms fibrous tissue, a small granuloma, around the gland’s oily material, and the lump becomes hard, like a small seed. At this stage compresses are rarely enough, because heat can no longer liquefy the contents.

A chronic chalazion is not dangerous, but it does need to be assessed. There is one important point to watch: when a “chalazion” keeps coming back in exactly the same spot, especially in older people, or when it comes with loss of eyelashes and changes to the eyelid margin, the ophthalmologist will consider the possibility of a different lesion and may recommend a histological examination (biopsy). This is rare, but that is exactly why a persistent lump should be seen by a doctor.

How a chalazion is diagnosed in the clinic

The diagnosis is clinical and is made at the slit lamp, the ophthalmologist’s microscope. We examine:

• the size, position and firmness of the lump
• whether there is acute inflammation or secondary infection (redness, warmth, pain)
• the condition of the meibomian glands and whether blepharitis is present
• the quality of the tear film, as gland dysfunction is often linked to dry eye
• the cornea, to see whether pressure from the chalazion is affecting vision

Based on these findings we decide whether to continue with conservative care, whether medication is needed, or whether a minor removal procedure is the better option.

Chalazion removal: how the minor procedure is done

Chalazion removal is a short, painless procedure done under local anaesthetic, taking about 10 to 15 minutes. The steps are as follows:

1. Local anaesthetic: after anaesthetic drops, a small injection of anaesthetic is given in the eyelid. This is the only moment you may feel a sting.
2. Stabilising the eyelid: a special clamp holds the eyelid steady and protects the eye.
3. Small incision: for most chalazia the incision is made on the inner side of the eyelid, so no scar is left on the skin.
4. Removing the contents: the oily material and any fibrous tissue that has formed are cleaned out.
5. Dressing: ointment and a pad are applied for a few hours.

Over the following days, an antibiotic and anti-inflammatory ointment or eye drops are usually prescribed. Mild swelling or a small bruise is normal and settles within a few days. Most patients return to work the next day.

Steroid injection: when is it an option?

For some small or medium-sized chalazia, especially those close to areas where we want to avoid an incision, a local corticosteroid injection into the chalazion may be suggested. The injection helps the inflammation shrink within one to two weeks. It is not suitable for everyone: in people with darker skin it can leave a patch of lighter skin, and it is not used when there is an active infection. The decision is made by the ophthalmologist after the examination.

Common mistakes that slow down healing

• Pressing or squeezing: this pushes the contents deeper into the tissue and can lead to a secondary infection.
• Compresses for a few minutes once a day: to work, they need 10 minutes, 3 to 4 times a day, for several days.
• Compresses that are too hot: eyelid skin is thin and burns easily. The temperature should be warm but comfortable.
• Make-up and contact lenses: it is best to stop using them until the inflammation has settled.
• Antibiotics without good reason: a chalazion is not a bacterial infection. An antibiotic is only needed when there is a secondary infection, on a doctor’s advice.
• Waiting for months: a chalazion that has not improved within a month is worth having examined.

Prevention: how to reduce the chance of it coming back

Recurrent chalazia are almost always a sign that the meibomian glands are not working properly. Prevention targets exactly that:

• Daily eyelid hygiene: a warm compress for a few minutes and gentle cleaning of the eyelid margins with dedicated wipes or solution, especially if you have blepharitis.
• Treating underlying conditions: rosacea, seborrhoeic dermatitis and chronic blepharitis significantly increase how often chalazia occur and need targeted treatment.
• Removing make-up properly: make-up should not be left on the eyelashes overnight, and old eye products are best replaced every few months.
• Contact lenses: clean them properly and stick to the replacement schedule.
• Screen breaks: we blink less when looking at a screen, and this puts a strain on how the glands work.

Patients with very frequent chalazia may also need a milder long-term treatment, which we adjust according to how the glands look at the examination.

When to see an ophthalmologist straight away

Most of the time a chalazion is a nuisance but harmless. However, some situations need an urgent examination:

• the swelling spreads across the whole eyelid or around the eye and becomes red and warm
• there is a fever or severe pain
• your vision becomes blurred or you see double
• the lump bleeds or changes shape quickly
• a young child has a swollen eyelid and is unsettled

At our clinic in Neo Psychiko, Athens, Dr. Vasileios Skouteris examines adults and children with a chalazion and, when needed, removes it on the same day. To book an appointment, call 210 677 0007.

Chalazion during pregnancy and breastfeeding

The hormonal changes of pregnancy affect secretions from the glands of the skin and eyelids, which is why quite a few women develop a chalazion for the first time during this period. The good news is that the basic treatment, warm compresses and eyelid hygiene, is completely safe for both mother and baby.

With medication, the approach is more cautious. Ointments and eye drops are only given when they are really needed, and after the ophthalmologist has chosen products considered safe during pregnancy or breastfeeding. If the chalazion does not go away, removal under local anaesthetic can usually be done, but we often prefer to wait until after the birth, as long as the chalazion is not painful and does not affect vision. In any case, tell your doctor that you are pregnant or breastfeeding before starting any treatment.

Frequently Asked Questions about Chalazion

Medically reviewed by: Dr. Vasileios Skouteris MD, FEBO