Chalazion: Diagnosis and Differentials
Clinical
History: A chalazion is usually a painless swelling on the eyelid that has been present for weeks to months. Patients may seek medical attention when a chalazion causes impaired vision, double vision, discomfort, or pain or becomes inflamed and painful, or infected.- The chief complaint must be examined in a thorough manner including questions concerning location, onset, duration, intensity, exacerbating and mitigating factors, previous intervention, and evaluation.
- Changes in visual acuity must be clearly documented.
- As the world becomes flatter, and intercontinental travel becomes easier, querying the patient about a travel history, particularly to locations known to be sources of leishmaniasis, is important.
- Leishmaniasis is found in rain forests in Central America and South America to deserts in West Asia.
- Leishmaniasis is found in some parts of Mexico and northern Argentina to southern Texas.
- India, Bangladesh, Nepal, Sudan, and Brazil are the common sources of visceral leishmaniasis.
- Leishmaniasis is not found in Australia or Oceania (ie, islands in the Pacific, including Melanesia, Micronesia, and Polynesia).
- Leishmaniasis is not common in travelers to southern Europe or Southeast Asia.
- Document recent viral infections.
- Document immune competency status. Does the patient have frequent skin infections?
- Ask about exposure or history of TB.
Physical: Completely examine the eye and conjunctival surface.
- A chalazion is a palpable nodule on the eyelid.
- Chalazia usually are nontender, nonerythematous, and nonfluctuant.
- Invert the eyelid to visualize the palpebral conjunctiva and identify internal chalazia.
- Chalazia may grow to 7-8 mm in diameter.
- Injection of the conjunctiva is a common secondary finding.
- Examine preauricular nodes to help determine infection.
- No intraocular pathology should be found.
- Presence of fever or distant nodes is not consistent with a chalazion.
Causes: Chalazia are associated with the following:
- Seborrhea
- Acne rosacea
- Chronic blepharitis
- High blood lipid concentrations (possible risk from increased blockage of sebaceous glands)
- Leishmaniasis
- TB
- Immunodeficiency
- Viral infection
- Carcinoma
Differentials
LeishmaniasisTuberculosis
Other Problems to be Considered:
Blepharitis
Hyperimmunoglobulinemia E (hyper-IgE) syndrome
Meibomianitis
Meibomian cell carcinoma
Microcystic adnexal carcinoma
Plexiform neurofibroma
Sebaceous carcinoma
Squamous cell carcinoma
Staphylococcus aureus infection
Virus-induced infection
Workup
Lab Studies:
- An uncomplicated chalazion diagnosis requires the provider to be certain the eyelid lesion is a sterile inflammation that will resolve with limited intervention. The caveat is that the provider must be sure of the diagnosis before initiating empiric chalazion therapy. A devastating delay in diagnosing carcinoma, TB, leishmaniasis, immune competency, or bacterial infection could occur if these conditions are masquerading as a chalazion. The provider must ensure that the patient has an adequate understanding of the typical progression of an uncomplicated chalazion: resolution within 1 month. Recurrent symptoms, refractive errors, or persistent lesions should prompt the provider to further investigate the lesion.
- Fine-needle aspiration cytology of chalazia with atypical clinical presentation provides a means of documenting the diagnosis and excluding malignancy.
- Viral and bacterial cultures can provide results to include or exclude an infectious etiology.
- Visual acuity testing
- Visual field testing
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Synonyms And Related Keywords
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
