A chalazion on the eyelid — wait, treat or remove

What a chalazion is

An eyelid cyst — medically Chalazion — is a chronic build-up of blocked secretion in a meibomian gland of the eyelid. The meibomian glands lie in the cartilage-like plate of the lid and release an oily secretion into the tear film. If their duct becomes blocked, this secretion backs up inside the gland. The body responds not with an infection but with an encapsulating inflammatory reaction: a firm, clearly demarcated lump forms in the lid. That makes a chalazion one of the inflammations of the eye and lid that arise without a pathogen being involved.

That explains the two characteristics that make a chalazion what it is — and that a stye does not share: It is usually painless, and it does not go away in a few days. A chalazion is not an infection you have to 'get rid of' but a blockage that the body slowly breaks down. Weeks to months are normal.

Both the upper and the lower lid can be affected. From the outside the lump is visible as a bulge; turn the lid over and a reddened area often shows on the inner surface directly above it.

Symptoms and progression

• A firm, clearly defined lump in the upper or lower lid
• No or only slight tenderness to pressure — unlike with a stye
• A feeling of heaviness in the lid, and with larger findings a visibly altered blink
• Occasionally blurred vision, when the lump presses on the cornea from inside and deforms it slightly
• A foreign-body sensation, when the inner surface of the lid is irritated
• Often an accompanying inflammation of the eyelid margin with crusted or sticky eyelid margins

Some chalazia settle on their own within a few weeks under consistent application of warmth. Others persist for months, becoming smaller and firmer as they do — and then bother mainly in appearance.

Conservative treatment: warmth, massage, eyelid margin hygiene

The first step is always the same, and it calls for persistence rather than effort:

1. Warmth. A warm compress or heat mask for around ten minutes, two to three times a day. Warmth liquefies the congested secretion — without this step, everything else achieves little.
2. Massage straight afterwards. With your fingertip, stroke gently from inside the lid towards the eyelid margin, in the direction of the lashes. Do not press on the lump; help the gland to empty.
3. Eyelid margin hygiene. Clean the eyelid margin along the lash line with a clean damp cloth or a lid-cleaning product. Daily, even when nothing is bothering you at the time. Where the meibomian glands are persistently disturbed, dry eyes are often part of the same picture of symptoms.
4. Stick with it. Four to six weeks of consistency is a realistic timeframe before a procedure is discussed. Three days of warmth and then wanting an operation is the commonest reason for unnecessary procedures.

What is not help: squeezing, lancing, drawing ointments without an indication, antibiotic drops. A chalazion is not an infection — antibiotics have no part here, unless there is a bacterial inflammation of the eyelid margin as well.

When a procedure makes sense

We talk about a procedure when at least one of these points applies:

• The lump is still there after several weeks of consistent warmth treatment — unchanged.
• It is so large that it mechanically interferes with the lid, impairs eyelid closure or presses on the cornea and changes vision.
• It bothers you in everyday life — that too is a legitimate reason, and we treat it as one, without reinterpreting it as a medical necessity.
• It keeps coming back in the same place or it looks unusual. Then the tissue is examined under the microscope as well.

The procedure itself is small: under local anaesthetic the lid is turned over and the chalazion is opened from the inner surface and cleared out. That leaves no visible scar on the outside. The whole thing usually takes a few minutes, is done as an outpatient, and you go home with an ointment dressing. For one to two days the lid can be swollen and discoloured bluish.

Eyelid surgery is a focus of Sehklinik — eyelid operations are among our most frequent procedures, carried out in our own day clinics in Zurich and Wetzikon. For a chalazion that is not an argument for operating sooner. It is an argument that you do not have to carry it around for months if it bothers you.

When an eyelid lump is unusual

The great majority of eyelid lumps are harmless. A few are not — and those few look like a chalazion at the start. We look more closely at a lump that appears again and again in the same place or one that destroys the eyelid margin, or one where, in that area, eyelashes fall out, or one that bleeds or crusts over or one that over months slowly grows larger.

In these cases we send the removed tissue for examination under the microscope. That is not an alarm signal but good practice: the only way to certainty runs through the microscope — not through looking from the outside, and not through waiting either.

Costs and your health insurer

Assessment and treatment of a chalazion are medical services. Where there is a medical indication, the cost is covered by basic health insurance (OKP); the deductible and co-payment apply as at any doctor's appointment. For planned procedures you receive an itemised cost breakdown in writing beforehand, before you decide.

Questions about booking an appointment: +41 44 500 69 00, Mon–Fri 08:00–12:00 / 13:00–17:30.