Recurrent Chalazia: Causes, Risks, and Treatments

Q: Recurrent Chalazia: Causes, Risks, and Treatments

Hello： There are only hordeolum and chalazion. <br>I'm not sure what you mean by "gland" cyst; it could refer to hordeolum (stye) or chalazion (pronounced as "shian"). <br>However, the pathogenic and pathological causes of the two are different. <br><br>**Hordeolum** is an acute

Recurrent chalazion?

In March of this year, I developed a stye in the lower right area of my right eye.
I visited the ophthalmology department twice for medication, but the swelling did not subside.
By November, I went to the hospital's ophthalmology department, where the doctor diagnosed it as a chalazion and immediately performed an outpatient procedure to remove it.
However, about ten days later, it reappeared.
The doctor advised me to continue using medication and take antibiotics, and if the swelling does not subside, I would need to undergo surgery in the operating room and have it sent for pathology examination.

I would like to ask the following questions:
1.
Are chalazia, hordeola (styes), and meibomian cysts the same?
2.
What is the likelihood of malignancy if a chalazion recurs?
3.
If it is malignant, what would be the extent of surgical intervention? What is the postoperative condition like? What is the possibility of metastasis? Thank you, doctor.

A-Hua, 40~49 year old female. Ask Date: 2011/12/21

Dr. Gao Pilin reply Ophthalmology

Hello: There are only hordeolum and chalazion.
I'm not sure what you mean by "gland" cyst; it could refer to hordeolum (stye) or chalazion (pronounced as "shian").
However, the pathogenic and pathological causes of the two are different.

Hordeolum is an acute purulent inflammation of the eyelid margin, commonly known as a stye.
The primary cause is Staphylococcus bacteria.
Symptoms include redness, swelling, pain of the eyelid, conjunctival hyperemia, tenderness in the swollen area, and significant spontaneous pain.
Depending on the site of inflammation, it can be classified into two types:
1.
External hordeolum: This is an acute purulent inflammation of the sebaceous glands associated with eyelashes (Zeis glands, Moll glands), usually resulting in surface suppuration.
2.
Internal hordeolum: This is an acute purulent inflammation of the meibomian glands (Meibomian glands), leading to conjunctival sac swelling and suppuration.
Chalazion is a chronic granulomatous inflammation of the meibomian glands caused by a foreign body inflammatory response following gland obstruction.
Symptoms include a hard, painless lump that can be felt under the eyelid, which is not adhered to the skin but is fixed to the tarsus.
There is no tenderness or spontaneous pain.
It gradually enlarges and may sometimes rupture on the conjunctival surface, forming a polyp.
Comparing these two eye conditions, both occur on the eyelids and are clinically similar.
However, a chalazion is a lump caused by chronic inflammation of the meibomian glands, while a hordeolum is an acute bacterial infection of the hair follicles or glands, resulting in redness, swelling, heat, and pain of the eyelid margin.
The location of hordeolum is at the eyelid margin, while chalazion occurs further away from the eyelid margin.
The lump can be palpated on the eyelid or seen on the conjunctival surface when the eyelid is everted.
Treatment for hordeolum includes:
1.
Oral antibiotics or steroid eye drops.
2.
Warm compresses: Applying a warm towel for 10-15 minutes, three to four times a day, is the best method for treating and preventing hordeolum.
Treatment for chalazion: If the chalazion is small and asymptomatic, no treatment is necessary, as it usually resolves on its own within a few months.
Warm compresses can promote vasodilation and aid absorption.
Regarding recurrent chalazia turning malignant, you may refer to an article by Dr.
Kao Shu-Ching from the Department of Ophthalmology at Taipei Veterans General Hospital, which discusses the possibility of sebaceous gland carcinoma in older adults with recurrent chalazia.
The link is as follows: http://www1.vghtpe.gov.tw/msg/中老年人復發性霰粒腫930422.htm

Reply Date: 2011/12/21

More Info

Recurrent chalazia, often referred to as meibomian gland cysts, can be a frustrating condition for many patients. Understanding the causes, risks, and treatments is essential for effective management.

1. Understanding Chalazia, Hordeola, and Other Related Conditions
Chalazia, hordeola (commonly known as styes), and meibomian gland dysfunction are related but distinct conditions. A hordeolum is an acute infection of the eyelid's oil glands, typically caused by bacteria, leading to a painful, swollen lump. In contrast, a chalazion is a chronic inflammatory lesion that occurs when a meibomian gland becomes blocked, resulting in a painless swelling. While both conditions affect the eyelids, their underlying causes and treatment approaches differ.

2. Causes and Risk Factors
Chalazia can recur for several reasons, including:
- Meibomian Gland Dysfunction: Blocked glands can lead to the formation of chalazia. Factors such as poor eyelid hygiene, skin conditions (like rosacea), and environmental irritants can contribute to this dysfunction.

- Chronic Inflammation: Conditions like blepharitis (inflammation of the eyelid margins) can predispose individuals to recurrent chalazia.

- Systemic Conditions: Certain systemic diseases, such as diabetes or autoimmune disorders, may increase the risk of developing chalazia.

3. Malignancy Concerns
Regarding your question about the malignancy potential of recurrent chalazia, it is important to note that while chalazia themselves are benign, any persistent or recurrent eyelid lesion should be evaluated carefully. The likelihood of a chalazion being malignant is low, but it is not impossible. The risk of malignancy increases if there are atypical features, such as rapid growth, changes in color, or associated symptoms like pain or bleeding. If a chalazion is recurrent and does not respond to standard treatments, further evaluation, including a biopsy, may be warranted to rule out malignancy.

4. Surgical Considerations
If surgical intervention is necessary, the procedure typically involves incision and drainage of the chalazion. This is usually performed under local anesthesia in an outpatient setting. The surgeon will remove the contents of the chalazion and may also express the meibomian gland to help prevent recurrence.
Post-operative care is crucial. Patients are often advised to apply warm compresses to the area to promote healing and reduce swelling. The risk of complications, such as infection or scarring, is generally low, but patients should be monitored for any unusual changes.

5. Follow-Up and Monitoring
After surgery, follow-up appointments are essential to monitor healing and assess for recurrence. If a chalazion recurs, further treatment options may include:
- Topical or Oral Antibiotics: To address any underlying infection or inflammation.

- Steroid Injections: To reduce inflammation and promote healing.

- Surgical Excision: If conservative measures fail, a more extensive surgical approach may be necessary.

Conclusion
In summary, recurrent chalazia can be a challenging condition, often requiring a multifaceted approach to treatment. Understanding the differences between chalazia and other eyelid conditions, recognizing the potential for malignancy, and adhering to proper follow-up care are critical components of effective management. If you have ongoing concerns or if your symptoms persist, it is advisable to consult with an ophthalmologist for a comprehensive evaluation and tailored treatment plan.

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