What is Chalazion? Its causes risk factors and treatment - What Studies | Knowledge

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Saturday, 11 May 2019

What is Chalazion? Its causes risk factors and treatment


A chalazion is a Chronic Inflammatory Lipogranuloma of the Meibomian gland. This is not a cyst but a chronic inflammatory granuloma of a meibomian gland.

Etiology:

It is caused by the obstruction of the orifice of the Meibomian gland either by infection or due to an unknown cause, which results into the accumulation of the sebaceous secretion within the acne of the gland.

It is probably due to chronic irritation caused by an organism of low virulence. The glandular tissue is replaced by granulation tissue containing giant cells, plasma cells, histiocytes, polymorphonuclear leucocytes due to chronic irritation predominantly. It is often multiple in number occurring in corps.
It is more common in adults than in children.

Symptoms:

  • There is no pain unless chalazion is secondarily infected.
  • There is disfigurement due to the presence of a hard, painless swelling in the lid increasing gradually in size.
  • It may be single or multiple in number.

Signs:

  • A small non-tender hard swelling in the lid, slightly away from the lid, the margin is seen.
  • There are no signs of acute inflammation.
  • On everting the lid, the conjunctiva over the swelling is red or purple. It is grey in color in the later stages. It may be yellow when secondarily infected by pyogenic organisms.

Precipitating factors:

It is common in the following conditions:
  1. Blepharitis.
  2. Diabetes mellitus.

Pathogenesis:

When there is obstruction of the orifice of the gland, the retention of the lipid secretion induces chronic inflammatory reaction around it. 

A large number of epithelioid and giant cells surrounds the sebaceous gland acini and their contents. Plasma cells, lymphocytes, and neutrophils are also present in the lesion. This retained lipid secretion along with inflammatory reaction produces clinically visible swelling in the eyelid.

Clinical Features:

  • It is more common in upper eyelid because of the number of meibomian glands are more in upper than the lower eyelid.
  • It is characterized by gradual painless swelling in the eyelid without other external signs of acute inflammation.
  • Palpation indicates a small nodule in the substance of the eyelid.
  • Eversion of the lid shows that conjunctiva is red or purple over nodule or there may be a fleshy mass if the lesion has ruptured through the conjunctiva.
  • Blurred vision may occur due to astigmatism caused by large chalazion of upper eyelid pressing on the cornea.

The fate of chalazion:

  • Once chalazion is developed then it may follow one of the following courses:
  • Spontaneous complete resolution may occur rarely:
  • Get fibrosed into a hard nodule
  • Liquify to form a thin fibrous sac containing a glairy fluid called chalazion cyst.
  • Calsify and form a very hard nodule.
  • Get infected and suppurate.
  • Brust through the conjunctiva to present as fleshy mass.

Complications:

Mechanical ptosis.
Astigmatism causing blurring of vision. It is due to mechanical pressure over twelve o’clock position of the cornea.

Treatment :

Small soft  recent a chalazion may undergo self resolution and disappear spontaneously but it can be helped by conservative treatment in the form of :
  • Expression
  • Hot formentation
  • Topical Steroid: Antibiotic combination drops.
  • Anti-inflammatory drops.

The large and persistent chalazion require the following treatment:

Medical:

Corticosteroid injection:
It is a good alternative to surgery. Triamcinolone acetonide 0.1-0.2 ml is injected into the lesion through the conjunctiva. The success rate following one injection is 80%. In unresponsive cases, the second dose may be repeated after two weeks, useful in multiple chalazia.

Systemic antibiotics:
May be required for chalazion associated with acne rosacea or blepharitis.

Surgical Treatment:

Surgery is the most common method of treatment .the lesion is incised and content is curetted from the conjunctival side.

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