Excerpt from Chalazion

Synonyms, Key Words, and Related Terms: chalazion, chalazia, nodule on eyelid, meibomian glands, deep chalazion, Zeis sebaceous glands, superficial chalazion, painless granuloma on eyelid, painless swelling on eyelid, seborrhea, acne rosacea, chronic blepharitis, high blood lipid concentrations

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Background: A chalazion is a slowly enlarging nodule on the eyelid formed by inflammation of the meibomian glands (deep chalazion) or Zeis sebaceous glands (superficial chalazion). Chalazia are often recurrent.

It is difficult to state definitively the origin of the word chalazion (pleural: chalazia).

Reported origins include a Greek word meaning small lump, a Greek word meaning hailstone, and a Greek word meaning pimple.

Pathophysiology: A chalazion forms when the meibomian gland becomes blocked. If the gland ruptures through the tarsal plate, granulation tissue results. Histopathology includes the following:

Infiltration of fibroblasts, capillaries, lymphocytes, and plasma cells
Multinucleated giant cells (resembling foreign body giant cells)
Asteroid bodies
Schaumann bodies
Zonal granulomatous reaction centered on clear spaces previously filled with lipid but dissolved out during tissue processing

Chalazion sites

The large meibomian glands are embedded in the tarsal plate of the eyelid; therefore, edema usually is contained on the conjunctival portion of the lid. Occasionally, the chalazion enlarges and breaks through the tarsal plate to the external portion of the eyelid. The Zeis glands may induce chalazia to occur along the lid margin.

A hordeolum is an acute infection of the Zeis glands, while a chalazion is usually sterile. Following the acute inflammation of a hordeolum, a chalazion may occur, in which case the lesion becomes less painful and eventually painless.

Frequency:

In the US: Exact incidence of chalazia in the US is not known; however, chalazia are common. Acne rosacea and chronic blepharitis are 2 predisposing skin and eyelid conditions that affect true incidence. Dry eye syndrome may be another associated factor.

Internationally: No known difference exists in international prevalence.

Mortality/Morbidity:

Disease progression of a chalazion leads to a painless granuloma that may be disfiguring cosmetically.

Centrally located chalazion can cause visual disturbances by deforming the cornea causing mechanical with-the-rule astigmatism. Acquired hyperopia and decreased vision has been caused by a chalazion of the upper eyelid.

Most morbidity is secondary to infection caused by improper drainage. An ophthalmologist or one familiar with eyelid anatomy and necessary surgical techniques best performs proper surgical management.

Race: No predilection exists, but blepharitis and acne rosacea are more common in fair-skinned males, which may increase incidence of chalazia in that group.

Ocular leishmaniasis with eyelid and conjunctival involvement can simulate a chalazion. It is imperative to question the patient about recent travel history to Middle Eastern countries.

Sex: Males more commonly are affected, possibly from increased androgenic hormone and associated skin changes arising from that hormone's effect.

Age: Chalazia are more common in adults than in children. Risk of developing chalazia increases in those aged 30-50 years.

Recurrent chalazion, particularly in the elderly patient, should prompt the practitioner to consider conditions masquerading as a chalazion such as sebaceous carcinoma, squamous cell carcinoma, microcystic adnexal carcinoma, or tuberculosis.

Children or young adults with recurrent chalazion should prompt the practitioner to examine the patient for viral conjunctivitis and hyperimmunoglobulinemia E (hyper-IgE) syndrome (Job syndrome).