Chalazion: Treatment and Medication
Treatment
Prehospital Care: Double vision or refractive error may cause the patient to contact EMS.EMS personnel should provide protocol-based evaluation and stabilization for the patient who complains of visual disturbance.
The eye can be patched, and the patient should be kept comfortable during transportation.
Emergency Department Care:
- To conservatively manage chalazia, apply warm compresses for 15 minutes (4 times per day on outpatient basis). More than 50% of chalazia resolve with conservative treatment.
- Defer steroid injections and surgical drainage to an ophthalmologist or plastic surgeon.
- Recognize that injection and removal of chalazia may create cosmetic morbidity (see below).
- Ophthalmology texts indicate that topical or systemic antibiotics are not necessary. Although most ophthalmologists and ED texts still recommend topical antibiotic cream, tetracycline for a chronic chalazion also has been recommended.
- Steroid injection into chalazion generally is not performed in the ED.
- If no evidence of infection is present, inject the chalazion with a steroid (eg, triamcinolone, methylprednisolone).
- Steroids stop inflammation and frequently cause regression of the chalazion within a few weeks.
- Inject 0.2-2 mL of 5 mg/mL triamcinolone directly into chalazion's center. A second injection may be necessary.
- Complications of steroid injections include hypopigmentation, atrophy of the area, corneal perforation and traumatic cataract, and potential exacerbation of bacterial or viral infection.
- Excision of chalazion generally is not performed in the ED.
- If necessary, make a vertical incision in the palpebral conjunctival surface.
- For small chalazia, perform curettage of the inflammatory granuloma in the lid. For larger chalazia, dissect the granuloma for complete removal.
- Cauterize or remove the meibomian gland (usually).
- For chalazia extending to the skin, incise the skin surface horizontally rather than through the conjunctiva to completely remove the inflammation.
- Involvement of the lid margins raises additional concern of disfigurement.
Consultations: Refer patients for follow-up care with an ophthalmologist after 2 weeks if conservative management does not completely resolve the chalazion.
Medication
Since chalazia are sterile inflammations, topical antibiotics may not assist in treatment. However, many physicians recommend their use in patients with a minor infection.
Drug Category: Ophthalmic antibiotics -- Therapy must cover all likely pathogens in the context of the clinical setting.
| Bacitracin ophthalmic solution (AK-Tracin, Baciguent) -- Prevents transfer of mucopeptides into growing cell wall, inhibiting cell wall synthesis and bacterial replication. | |
| Adult Dose | 2 gtt qid in affected eye |
|---|---|
| Pediatric Dose | 1 gtt qid in affected eye |
| Contraindications | Documented hypersensitivity; vaccinia, varicella, epithelial herpes simplex keratitis, mycobacterial infections, and fungal diseases of the eye; patients using steroid combinations after uncomplicated removal of a corneal foreign body |
| Interactions | None reported |
| Pregnancy | C - Safety for use during pregnancy has not been established. |
| Precautions | Ophthalmic ointments may delay healing of corneal epithelia; in deep-seated eye infections, supplement with systemic medications; prolonged use may result in overgrowth of nonsusceptible organisms |
| Tobramycin (Tobrex) -- Interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits, resulting in defective bacterial cell membrane. | |||||||||
| Adult Dose | 1-2 gtt q4h in affected eye while awake and less frequently at night | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Pediatric Dose | <2 years: Not established >2 years: Administer as in adults Contraindications | Documented hypersensitivity | Interactions | None reported | Pregnancy |
C - Safety for use during pregnancy has not been established.
| Precautions | Do not use in deep-seated ocular infections or in those that may become systemic; prolonged use of antibiotics may result in bacterial or fungal overgrowth of nonsusceptible organisms | |
| Erythromycin ointment (E-mycin, Eryc) -- Indicated to treat infections caused by susceptible strains of microorganisms and to prevent corneal and conjunctival infections. | |
| Adult Dose | Apply 0.5-inch (1.25 cm) ribbon bid for 2-8 d inside eyelid |
|---|---|
| Pediatric Dose | Administer as in adults |
| Contraindications | Documented hypersensitivity; viral, mycobacterial, and fungal eye infections; patients using steroid combinations after uncomplicated removal of a foreign body from cornea should avoid using this product |
| Interactions | None reported |
| Pregnancy | B - Usually safe but benefits must outweigh the risks. |
| Precautions | Do not use topical antibiotics to treat ocular infections that may become systemic; prolonged or repeated antibiotic therapy may result in bacterial or fungal overgrowth of nonsusceptible organisms and may lead to secondary infection (take appropriate measures if superinfection occurs) |
| Gentamicin (Genoptic, Ocu-Mycin) -- Aminoglycoside antibiotic used for gram-negative bacterial coverage. | |||||||||||
| Adult Dose | Ointment: Apply 0.5-inch (0.04-cm) ribbon bid/tid to affected eye(s), q4h while awake and less frequently at night Solution: 1-2 gtt q4h, up to q1h for severe infections while awake and less frequently at night Pediatric Dose | <2 years: Not established | >2 years: Administer as in adults Contraindications | Documented hypersensitivity; mycobacterial, viral, and fungal eye infections; patients using steroid combinations after uncomplicated removal of a foreign body from cornea should avoid using this product | Interactions | None reported | Pregnancy |
C - Safety for use during pregnancy has not been established.
| Precautions | Do not use to treat ocular infections that may become systemic; prolonged or repeated antibiotic therapy may result in bacterial or fungal overgrowth of nonsusceptible organisms and may lead to secondary infections | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Tetracycline (Sumycin) -- Treats gram-positive and gram-negative organisms as well as mycoplasmal, chlamydial, and rickettsial infections. Inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s). | |
| Adult Dose | 250 mg PO qid |
|---|---|
| Pediatric Dose | Not established |
| Contraindications | Documented hypersensitivity; severe hepatic dysfunction |
| Interactions | Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy; tetracyclines can increase hypoprothrombinemic effects of anticoagulants |
| Pregnancy | D - Unsafe in pregnancy |
| Precautions | Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last one-half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines |
Drug Category: Corticosteroids -- Have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.
| Triamcinolone (Amcort) -- For inflammatory dermatosis responsive to steroids; decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability. | |
| Adult Dose | 0.2-2 mL of 5 mg/mL injected directly into chalazion's center; second injection may be necessary |
|---|---|
| Pediatric Dose | Not established |
| Contraindications | Documented hypersensitivity; fungal, viral, and bacterial skin-infections |
| Interactions | Coadministration with barbiturates, phenytoin, and rifampin decreases effects of triamcinolone |
| Pregnancy | C - Safety for use during pregnancy has not been established. |
| Precautions | Multiple complications (eg, severe infections, hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression) may occur; abrupt discontinuation of glucocorticoids may cause adrenal crisis |
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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
