Management of Chalazion

Treatment Algorithm

• Initiate conservative therapy with warm compresses and lid hygiene for 2–4 weeks; if the lesion persists, proceed to intralesional triamcinolone acetonide injection (0.2 mL of 10 mg/mL); reserve incision and curettage for cases that fail medical therapy or when malignancy is suspected. 1, 2

Conservative Management (First‑Line)

• Apply warm compresses to the affected eyelid to facilitate meibomian gland drainage. 2
• Perform eyelid cleansing and gentle massage to express meibomian gland secretions. 2

Surgical Management (Third‑Line)

• Perform incision and curettage only after steroid injection failure or when there is clinical suspicion of malignancy. 1, 2

Biopsy and Malignancy Evaluation

• Obtain a biopsy for a solitary, recurrent chalazion that is unresponsive to therapy, especially when the lesion is markedly asymmetric or unilateral. 1, 2
• Indications for tissue biopsy include loss of normal eyelid margin anatomy, focal lash loss (ciliary madarosis), or abnormal surrounding tissue changes to rule out sebaceous carcinoma. 1, 2
• Prior to biopsy for suspected sebaceous carcinoma, consult pathology to discuss the use of frozen sections and conjunctival mapping for pagetoid spread. 1, 2
• Unilateral, recurrent, or treatment‑resistant chalazia may represent sebaceous carcinoma masquerading as a benign lesion. 1, 2

Contributing Factors to Recurrence

• Underlying ocular surface conditions such as meibomian gland dysfunction, rosacea, or Demodex infestation can predispose to chalazion recurrence. 1