Chalazion(Etiology,symptoms,signs,complication,treatment)




The tarsal or meibomian cyst is a chronic non-infective (non-suppurative) lipogranulomatous inflammation of the meibomian gland is called a chalazion.
This is the commonest of all lid lumps.

Glands of eyelids

  1. Meibomian glands
  2. Glands of Zeis
  3. Glands of moll
  4. Accessory lacrimal glands of wolverine

Etiology

  1. Predisposing factors are similar to a hordeolum.
  2. Pathogenesis. First, there occurs mild grade infection of the meibomian gland by organisms of very virulence. The pent-up and extravasated secretion act like an irritant and excite non-infective lipogranulomatous inflammation of the meibomian gland and surrounding tissue.

Symptoms

  1. Painless swelling in the eyelid, gradually increases in size is the main presenting symptom.
  2. The Mild heaviness in the lid may be felt with moderately large chalazion.
  3. The Blurred vision may occur occasionally due to induced astigmatism by a very large chalazion pressing on the cornea.
  4. The Watering may occur sometimes due to eversion of the lower punctum caused by a large chalazion of the lower eyelid.

Signs

  1. The Nodule is noted slightly away from the lid margin which is firm to hard and non-tender on palpation.
  2. The Upper lid is involved more commonly than the lower lid probably because of the fact that the upper lid contains more meibomian glands than the lower lid. Frequently multiple chalazia may be seen.
  3. The Reddish purple area, where the chalazion usually points, is seen on the palpebral conjunctiva after eversion of the lid.
  4. Projection of the main bulk of the swelling on the skin side may be seen rarely instead of the conjunctival side.
  5. The Marginal chalazion, may present as a small reddish-grey nodule on the lid margin.

Complication

  1. Complete spontaneous resolution may occur rarely.
  2. It increases slowly in size is often seen and eventually it may become very large.
  3. The Fungating mass of granulation tissue may be formed occasionally when the lesion bursts on the conjunctival side.
  4. Secondary infection may lead to the formation of hordeolum internum.
  5. Calcification may occur, though very rarely.
  6. The Malignant change into meibomian gland adenocarcinoma may be seen occasionally in elderly people.

Treatment

  1. Conservative treatment. The small, soft, and recent chalazion, self resolution may be helped by the treatment of hot fomentation, topical antibiotic eye drops, and oral anti-inflammatory drugs.
  2. The Intra-lesional injection of long-action steroid is reported to cause resolution in about 50% of cases, especially in small and soft chalazia of recent onset, located near the puncta, where incision and curettage may cause damage.
  3. The Incision and curettage is the conventional and effective treatment for chalazion, surface anesthesia is obtained by installation of xylocaine drops in the eye. 
  4. The Diathermy. A marginal chalazion is treated by diathermy.
  5. The Oral tetracycline is given by Prophylaxis in recurrent chalazion, especially if associated with acne rosacea or seborrhoeic dermatitis. 
Written by Barsha Panth

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