The chalazion is a cystic, inflammatory, which corresponds to the increase in volume of some glands inside the eyelids. These glands secrete the lipid composition of the tear film, which appears on the surface of the eye with each blink. The glands are inside the eyelids and their secretion channels open at the free edge of the eyelids, near the genes. If these channels close, the glands grow in volume by the accumulation of lipid secretion that cannot be eliminated. On palpation, the chalazion appears as a cyst that can be painful at the touch and may turn red, especially in the first week of evolution. If the cyst does not decrease in volume after the treatment recommended by the physician, then it must be removed surgically.
Fig.1 Stye, upper eyelid Fig .2 Chalazion, lower eyelid
Chalazion occurs frequently in patients with chronic blepharitis and acne rosacea. The acute form may be similar to a stye at onset and is virtually impossible to differentiate clinically. The lesion may spontaneously drain or may persist as a chronical node, usually located a few millimeters away from the edge of the eyelid. A chalazion can be insidious in the form of a painless node. A large chalazion on the upper eyelid induces astigmatism.
The diagnosis is based on the typical appearance of the lesion. Differential diagnosis should include sebaceous carcinoma and basal cell carcinoma. Therefore, the histopathological examination is important for these lesions. The histopathological examination reveals lipogranulomatous inflammation, with clear, lipid-compartmented spaces surrounded by foreign body cells, neutrophils, lymphocytes, eosinophils, and a pseudofibrosis capsule that is frequently formed around the lesion. Treatment varies depending on the stage of the lesion. For chronic salivary, intralesional injections of corticosteroids or surgical treatment are indicated. A small chalazion can be extracted through incision and curettage.
Fig.3 Internal chalazion, lower eyelid Fig.4 External salazion, lower eyelid
Surgery can be done by incision on the skin (if the chalazion is external) or inside the eyelid (via the conjunctiva) if it is internal. Anesthetic drops are previously instilled, the eyelid and the skin are disinfected and an injection is made in the eyelid, near the cyst.
A hemostatic bandage is applied to reduce bleeding. After the incision, the cyst is revealed, which is formed by a wall and a fat content, usually superinfected. Cyst lining is incised, and the content is extracted in its entirety. If the incision is through the inside, to the conjunctiva, there is no scarring. The eye is covered until the next day, when the first check-up is done. Postoperatively, the physician recommends a treatment. After the intervention, the affected eyelid may have an ecchymosis and a slight swelling. If there are sutured, they are extracted after 7 days. It is possible that the chalazion will reappear in another area of the same eyelid or of the other eye.