What is it?
Chalazion (which is the Greek word for hailstone) is a lump that develops in the eyelids (more commonly the upper one). The chalazion is otherwise called meibomian cyst. The meibomian glands are very small organs that lie in the back surface of the eyelids (the one towards the eye ball) and they produce an oily fluid which is part of the tears. The meibomian glands have a small duct/pipe that drains the oily fluid they produce. When this duct gets blocked, the oily fluid cannot be drained and it accumulates causing the gland to get bigger and bigger. It is a very common condition that affects both sexes equally. It is more common in adults than children. People who develop a chalazion have a tendency to have more in the future. Poor hygiene of the eyelids and local infection are factors that can cause blockage of the draining duct of a meibomian gland and lead to the development of a chalazion.
A chalazion grows over a period of a few weeks and usually doesn’t cause pain or any other problems. Rarely, it can become enlarged and can press on the eye ball and affect the vision. If a chalazion gets infected it can become red, swollen and painful.
The operation
The operation can be done as a day surgery procedure, which means that you can go home on the same day of the operation. The operation is performed under local anaesthetic, which is applied with a small injection into the eyelid. Sometimes an anaesthetic cream is also applied locally to minimise the discomfort from the injection.
When the chalazion is relatively small, it can be removed through a small cut at the back of the eyelid. The eyelid is lifted so that the surgeon has access to the back surface of it and a small cut (about 3mm) is made just on top of the chalazion. The lump is then removed and pressure is applied for a few minutes to stop any oozing of blood that may occur because of the operation. There is no need for stitches and since the cut is at the back of the eyelid, it doesn’t show and the cosmetic result is excellent. If the chalazion is large and pushes on the skin of the eyelid then it is usually removed via a small cut in front of the eyelid through the skin. The cut is again about 3mm and is on top of the chalazion. After removal of the lump the application of pressure locally stops any oozing of blood in the area. The cut on the skin of the eyelid is closed with very fine (hardly visible) stitches which provide a very good cosmetic result when they are removed, usually five to seven days later. The removed chalazion is usually sent to the laboratory to be examined under a microscope because very rarely it can harbour cancer.
Any alternatives?
The application of warm compresses on the eyelid (four to six times a day for 10 to 15 minutes each time) in combination with very gentle massage of the eyelid that has the chalazion, can lead many times to spontaneous opening of the blocked duct of the meibomian gland which allows the oily fluid to drain and cures the chalazion.
If there is infection in the area of the chalazion, the application of local antibiotic ointment for five to seven days can cure the infection, reduce the swelling in the area and subsequently allow the duct of the meibomian gland to open up and drain the accumulated oily fluid.
In some cases, the injection of anti-swelling medications (such as the steroids) in the area near the chalazion can reduce the local swelling caused by the presence of the chalazion and eventually helps the duct of the meibomian gland to open.
Those conservative treatments are effective in many cases. However, when the chalazion doesn’t respond to this kind of conservative treatment, or when it is too large, or when it comes back many times despite initial successful conservative treatment, surgery is the only appropriate treatment.
Before the operation
Stop smoking and get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT). Bring all your tablets and medicines with you to the hospital. On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.
After - in hospital
Following removal of a chalazion, most patients experience some very minor discomfort in the eye which can be easily controlled by taking medication. You can wash, bathe, or shower normally after the operation, but you must not get water in your eye for 7 to 10 days. If you have your hair washed, have it done with your head leaning backwards. Do not use makeup on your eyelids for one month. You will normally be able to go home on the day of your operation. You will be given a supply of eye drops, and shown how to put them in your eye. These are used to prevent infection and swelling in the eye. If you have stitches on the skin of your eyelid, they will be removed five to seven days after the operation. You will be given an appointment for the outpatient department for a check-up three to four weeks after you leave hospital. The results of the examination of the chalazion under the microscope will be available by then. The nurses will advise about sick notes, certificates, etc.
After- at home
Your eye will be covered by a pad and a protective plastic shield. This applies gentle pressure on the eye to prevent any local small leakage of blood after the operation. This can be removed six to eight hours after the operation. You can start driving the day after the operation. You can use any glasses you were using before the operation as soon as the pad is removed. If you wear contact lenses, do not put one in the operated side for eight weeks. Plan to go back to light work in one to two days, and a more heavy/manual job in 7 to 10 days.
Possible complications
The removal of a chalazion is a straightforward and safe procedure. Complications are rare and seldom serious. Some minor bleeding can occur in the area of the operation and this usually stops with the application of gentle pressure. Extremely rarely, you will need another operation to fix the problem. Also rarely, the area of the operation can become infected. If this happens you will need treatment with antibiotic eye drops and, possibly, antibiotic tablets. The worst problems following removal of chalazion occur when the removal is incomplete. In this case the area of the chalazion becomes scarred and lumpy and can sometimes cause significant discomfort in the eye. In this very rare situation you will need another operation to remove the remnants of the chalazion and the scarred tissue around it.
Overall, the results of the operation for removal of a chalazion are excellent. However, even if the surgery was a success, another chalazion can appear (people who have had a chalazion have higher chances of experiencing the same problem in the future) and in this case you may need another operation to remove it.
General advice
These notes should help you through your operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.
