How to prevent and remove chalazion?

Doctor's Answers (5)

Chalazions can be irritating and frustrating problems to have. As you know, they are lumps in the eyelids like so:

and they are related to an eyelid condition called Meibomian Gland Disease/Dysfunction (MGD). The Meibomian glands are oil glands in the eyelids which open at the edge of the eyelids behind the eyelashes.

They secrete a usually liquid oil that floats on your tears, thereby reducing evaporation of the tears. In patients with MGD, the oil becomes very thick like toothpaste, like so:

Here you can see the abnormal thick oil in a patient with MGD.

When the oil becomes thicker, it can block the oil gland and the collection then becomes a chalazion.

Although we don’t know exactly why the oil becomes abnormal, it is likely that bacteria living around the eyelids and in the oil gland change the oil to make it thicker.

Recent studies such as this (https://www.ncbi.nlm.nih.gov/pubmed/28093340) suggest that people with MGD have more bacteria in the eye and also more different types of bacteria in the eye.

As such, the first thing in managing patients with chalazions and MGD is what we call lid hygiene and warm compresses.

The warm compresses hopefully help in liquefying the oil a bit, and allow better flow out of the glands. Keeping the eyelids clean could also keep the numbers of bacteria down.

If a chalazion develops, and it recurs or fluctuates in size in the same spot without going away for a long time (eg weeks-months), it often means there is a chronic blockage of one particular oil gland.

In such a case, a simple office procedure to drain that oil gland (incision and drainage) solves the problem.

If chalazions develop, and keep recurring in different places in the 4 eyelids, the problem is more widespread and I often consider prescribing a course of antibiotics to deal with the problem.

The antibiotic could be doxycycline, or for some who are allergic to this it could be another type called azithromycin. The course of antibiotic treatment in these cases can be prolonged, lasting sometimes for more than a month.

If successful, the cycle of recurrent chalazia can be broken and patients can go for long periods without experiencing lid inflammation or lumps.

Demodex mites can coexist with chalazia, but in my experience they seem to be related more with eyelash crusting.

If I see many mites, I will simultaneously treat the eyelid with antiparasitic cream, but I believe the main methods of treating MGD and chalazia remain:

  1. Warm compress and lid hygiene
  2. Sometimes topical antibiotic ointment
  3. Incision and drainage for persistent chalazia
  4. Oral antibiotics for persistent symptomatic MGD (eye irritation, burning, redness) or very recurrent chalazia in different parts of the eyelids

In your case, where the chalazion came back in the same place, you could consider the drainage procedure especially if the lump is big or noticeable.

In addition to all the good advice that has been shared before this, I would like to highlight that a very common underlying cause of recurrent chalazions, that most people (even Doctors) overlook, is Demodex blepharitis.

Demodex is a microscopic eyelash mite (the scientific names for these that infest humans are Demodex Folliculorum and Demodex Brevis). Demodex tends to cluster at the eyelash roots and thus lead to blockage of the sebaceous glands which in turn lead to chalazion formation.

A large majority of patients I’ve seen with recurrent chalazions actually have untreated Demodex infestation of their eyelids. After appropriate treatment with anti-parasitic eye cream and anti-Demodex eyelid scrubs, there is no further recurrence of chalazions. There is however, a risk of getting Demodex infection in future if Demodex contamination occurs again.

How do you know if you have Demodex? Usually, Demodex will give rise to symptoms such itchy eyes, whitish discharge and subtle eyelid redness. Under the slit lamp, the eye doctor can see cylindrical deposits at the eyelash roots. To clinch the diagnosis for sure, usually I remove a single incriminating eyelash and inspect it under a microscope to visualise the Demodex mites.

If you are still troubled by recurrent episodes of chalazion formation, do get to the root of the problem by getting checked for Demodex mites under the microscope.

From experience, I’ve noticed that people with recurrent Demodex infection tend to travel frequently and tend to rub their eyes with their hands frequently. Demodex mites that are picked up by our hands from contaminated surfaces may be transmitted to our eyes through touch. The best way to prevent Demodex infection is to avoid touching your eyes with unclean hands.

Eradicating Demodex is easy with good medication and advice from your ophthalmologist. Don’t wait to get your eyelids checked!

I hope that this was helpful to you!

Dr David Chan
5.0

"Ophthalmologist with over 20 years of experience"

Having a recurring chalazion can be quite frustrating, especially when you are already taking the right steps and putting in your best efforts with warm compress to help soften the blockages of the oil glands around the eyelid margins as well as taking note of the hygiene around that area.

Despite all your best efforts, many people share your experience of having these chalazions or styes recur. In majority of cases, the swelling subsides after a period of regular warm compresses, lid cleansing with mild baby shampoo and avoidance of make up.

We do see our fair share of recurrent chalazions despite warm compressors and topical/oral antibiotics.

One other method of treatment is called incision and drainage, which you may consider if the above conservative methods you have mentioned do not help. However the mainstay of prevention of chalzion/stye formation remains to be regular warm compresses and treatment for inflammations of the eyelids.

Thank you for the question. Chalazions are common and are caused by the blockage and inflammation of the glands around the eyes.

You are absolutely right in using warm compresses to the eyes as this helps to open up the blocked glands. This should be done 3 to 4x a day. Keeping the eyelids  margins clean is also very helpful. To prevent recurring chalazions,  warms compresses can  be continued even when the chalazion has resolved.

If it is still persistent, topical or oral antibiotics like doxycycline can be prescribed and this usually settles the chalazion quickly.

Most chalazions will settle with the above measures but if the lump is persistent or refuses to clear, a visit to the ophthalmologist for surgical drainage should be considered.

Nonetheless, if the regular use of lid cleaners do not prevent chalazia from recurring, you should consider seeing your ophthalmologist who can help to optimise your eyelid health and hygiene.

Some options he may offer you would be a short course of antibiotic ointment to treat anterior blepharitis, or a short course of antibiotics to address any lipid abnormalities in patients with posterior blepharitis. 

These are some of the most common causes for recurrent chalazia. Its useful to consult your ophthalmologist who may be able to shed some light on why you keep experiencing these chalazia even though your eyelids seem clean to the naked eye.

ESG

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