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A nonpainful bump had been enlarging slowly on a 29-year-old woman's left upper eyelid. The patient wanted it removed for cosmetic reasons.

A nonpainful bump had been enlarging slowly on a 29-year-old woman's left upper eyelid. The patient wanted it removed for cosmetic reasons.

The bump is a chalazion (A), a noninfectious, acute or chronic inflammation of the meibomian glands. Typically, chalazia arise gradually and are rarely painful. However, pain can occur when the lesions are very large and cause sensory nerve endings to become distended.

Chalazia result from chronic obstruction of the secretory ducts of the meibomian glands. The secretory material accumulates, hardens, and forms a lipogranulomatous inflammatory nodule. Patients with seborrheic dermatitis or acne rosacea are at increased risk for single, multiple, or recurrent chalazia.

Since these lesions are inflammatory and not infectious, antibiotic therapy is of no value. The nodules occasionally drain spontaneously or shrink and resolve completely. Warm compresses and eyelid scrubs to remove debris that builds up along the anterior eyelid margins and eyelashes may be tried. For persistent lesions, consider giving a corticosteroid injection with triamcinolone acetonide or performing incision and curettage.

For the corticosteroid injection, use a 40-mg/mL concentration of triamcinolone acetonide. Inject a 0.10- to 0.20-mL dose directly into the lesion with a 27- or 30-gauge needle. The cure rate following a single injection is about 80%.1 If needed, a second injection can be given 2 weeks later.

Incision and curettage removes the affected meibomian gland (B). After the lid is anesthetized locally, a chalazion clamp is placed on the everted eyelid, and the gland is incised with a scalpel or trephine blade. The contents of the gland are scraped out with a curette, and the remaining gland tissue is dissected. Following the operation, the patient applies a topical antibiotic for about 5 days.

REFERENCE:1. Kanski JJ. Clinical Ophthalmology. 4th ed. Boston: Butterworth-Heinemann; 1999:12-13.

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