Chalazia: Symptoms, Types, Causes and Treatment

Chalazia are among the most common eyelid disorders, yet they remain misunderstood and sometimes mismanaged. For many, a chalazion is just a bothersome eyelid lump—but for others, especially children, it can affect vision and quality of life. This comprehensive article explores everything you need to know about chalazia: the symptoms you shouldn't ignore, the different types, what causes them, and the best evidence-based treatments available today.

Symptoms of Chalazia

When a chalazion develops, it can be subtle at first but often brings noticeable discomfort. Recognizing symptoms early helps guide proper management and avoid complications, such as visual impairment in children or recurrent infections in adults.

Symptom	Description	Severity	Source(s)
Eyelid lump	Localized, painless swelling	Mild/Moderate	3 2
Redness	Mild erythema around lesion	Mild	3
Tenderness	Slight discomfort or pressure	Mild	3
Visual changes	Blurred vision, astigmatism	Moderate/Severe	2
Tearing	Watery eyes	Mild	1
Burning	Sensation of heat or irritation	Mild	1
Light Sensitivity	Discomfort with bright lights	Mild/Moderate	1
Foreign body sensation	Feeling of something in the eye	Mild	1

Table 1: Key Symptoms

Common Symptoms and Their Progression

Chalazia usually start as a small, painless lump on the eyelid. Over time, the lump may become more noticeable, causing mild redness and swelling. Unlike a stye (hordeolum), chalazia are generally not acutely painful or tender unless secondarily infected or inflamed 3.

Visual Changes
In children, larger or centrally located chalazia can press on the eye, distorting the cornea and leading to astigmatism or blurred vision. This can be especially concerning if left untreated, as it may affect visual development 2.

Other Associated Symptoms
Patients often report:

• Tearing or watery eyes
• Mild burning or irritation
• Sensitivity to bright lights
• A sensation of having something in the eye (foreign body sensation) 1

How Chalazion Symptoms Differ from Other Eyelid Disorders

While chalazia are often confused with hordeola (styes), the two differ:

• Chalazion: Chronic, usually painless, and less likely to be red or hot.
• Hordeolum: Typically acutely painful, red, and often related to infection of the eyelash follicle or associated glands 3.

Impact on Daily Life

Most chalazia are a cosmetic nuisance, but in some cases—particularly when multiple or large—they can cause significant discomfort, impair vision, or even affect self-esteem in children and adults alike 2 3.

Types of Chalazia

The term "chalazion" covers more than just one simple eyelid cyst. Understanding the types can help guide both diagnosis and treatment.

Type	Gland Involved	Depth	Source(s)
Deep	Meibomian gland	Tarsal plate	3
Superficial	Zeis gland	Near lash line	3
Single	One lesion	Any location	2 8
Multiple	Several lesions	Any location	6 8

Table 2: Types of Chalazia

Anatomical Classification

Chalazia originate from blocked sebaceous glands in the eyelid. The two main anatomical types are:

• Deep Chalazion:

  • Originates from the Meibomian glands, which are embedded within the tarsal plate of the eyelid.
  • Tends to form a larger, firmer lump that may cause more pronounced swelling 3.

• Superficial Chalazion:

  • Arises from obstruction of the Zeis glands, which are closer to the eyelash margin.
  • Usually smaller and more superficial 3.

By Number and Size

• Single Chalazion:

  • Most common presentation, with one isolated lump 2 8.

• Multiple Chalazia:

  • Simultaneous occurrence of several chalazia, often seen in children or individuals with underlying risk factors such as Demodex infestation or meibomian gland dysfunction 6 8.

• Size Classification:

  • Small: less than 2 mm
  • Medium: 2–4 mm
  • Large: greater than 4 mm 4

Special Considerations: Recurrent Chalazia

Some patients experience frequent recurrences, sometimes in the same or different locations. Recurrent chalazia are often linked with underlying conditions like Demodex infestation, meibomian gland dysfunction, or chronic blepharitis 6 7.

Pediatric vs Adult Types

• Pediatric Chalazia:

  • More likely to be multiple, larger, and associated with meibomian gland dysfunction and Demodex infestation 6 8.
  • Increased risk for astigmatism and visual disturbance if left untreated 2.

• Adult Chalazia:

  • More likely to be single, but recurrence is more common in those with chronic eyelid inflammation or Demodex 5 7.

Causes of Chalazia

Understanding what leads to a chalazion is key to both prevention and targeted treatment. While the immediate cause is gland blockage, multiple underlying risk factors can set the stage.

Cause/Risk Factor	Mechanism	Notes	Source(s)
Gland Obstruction	Blocked Meibomian/Zeis	Main direct cause	3
Demodex mites	Infestation/inflammation	D. brevis, D. folliculorum	5 6 7 8
Blepharitis	Chronic eyelid inflammation	Increases risk	1 3
Meibomian Gland Dysfunction	Poor lipid flow	Often co-occurs	1 6
Rosacea	Inflammatory skin disease	Often ocular subtype	1
Prior Chalazion	Previous history	Higher recurrence risk	7
Poor lid hygiene	Accumulation of debris	Modifiable risk	4 13

Table 3: Causes and Risk Factors

Pathophysiology: How Chalazia Form

• Obstruction and Inflammation:
  Chalazia occur when the meibomian or Zeis glands in the eyelid become blocked, preventing normal oil (sebum) drainage. This causes a buildup of glandular secretions, eventually triggering a chronic inflammatory response known as lipogranulomatous inflammation 3.

The Role of Demodex Mites

• Demodex brevis and Demodex folliculorum:
  Recent studies have shown a strong association between chalazia and Demodex mite infestation, particularly D. brevis. These microscopic parasites live in the eyelash follicles and meibomian glands, leading to inflammation, gland dysfunction, and recurrent chalazia, especially in children and adults with multiple or persistent lesions 5 6 7 8.
• Impact on Recurrence:
  Patients with Demodex infestation have a significantly higher risk of recurrence. Quantitative mite counts (rather than mere presence) correlate with more severe and multiple chalazia 7 8.

Other Predisposing Factors

• Chronic Blepharitis and Meibomian Gland Dysfunction:
  These conditions cause chronic inflammation and poor gland function, both of which are linked to frequent chalazion formation 1 6.
• Rosacea:
  About 75% of patients with cutaneous rosacea also have ocular involvement, often presenting as blepharitis, meibomian gland dysfunction, and chalazia 1.
• Poor Lid Hygiene:
  Insufficient cleaning of the eyelid margin leads to debris build-up, which can block glands and provide an environment for mites and bacteria 4 13.
• Previous Chalazion:
  A past history of chalazia increases the likelihood of recurrence, particularly if risk factors are not addressed 7.

Treatment of Chalazia

Effective management of chalazia depends on size, number, symptoms, and underlying causes. Treatments range from simple home remedies to in-office procedures and, rarely, surgery. Evidence strongly supports a stepwise approach.

Treatment Type	Indication	Effectiveness	Source(s)
Lid hygiene & warm compress	First-line for mild/small lesions	29–80% resolution	4 9 13
Topical antibiotics/steroids	With inflammation or secondary infection	Adjunctive	4
Oral probiotics	Small chalazia, adjunct	Shortens recovery time	4
Intralesional steroid injection	Medium/large or persistent	70–85% resolution	10 11 12
Incision & curettage	Large or non-resolving lesions	72% success	9 11
Demodex treatment	Recurrent/multiple cases	Needed to prevent recurrence	6 7 8

Table 4: Treatment Options

Conservative (Non-invasive) Treatments

• Lid Hygiene and Warm Compresses:

  • The mainstay of initial chalazion management.
  • Involves gently cleaning the eyelid margins and applying a warm compress several times daily to soften gland contents and encourage drainage.
  • Studies show variable success (29–80% resolution), most effective for small and early lesions 4 9 13.

• Topical Antibiotics and Steroids:

  • Sometimes combined with lid hygiene if secondary infection or significant inflammation is present.
  • Dexamethasone/tobramycin ointment is a common choice 4.

• Oral Probiotics:

  • Recent pilot studies suggest that oral probiotics can significantly reduce the resolution time of small chalazia, highlighting a possible gut-eye inflammatory link 4.

Minimally Invasive Treatments

• Intralesional Steroid Injection:
  • Effective for medium-sized or persistent lesions, and as an alternative to surgical excision.
  • Triamcinolone acetonide injections lead to resolution in most patients (70–85%), with an average of 1–2 injections needed 10 11 12.
  • Particularly useful in patients for whom surgery is contraindicated or who wish to avoid surgical intervention 10 12.

Surgical Treatments

• Incision and Curettage:
  • Gold standard for large, chronic, or non-resolving chalazia, especially when conservative measures fail.
  • Performed by everting the eyelid, incising the lesion, and draining its contents.
  • High success rate (~72%) with low risk of complications 9 11.

Addressing Underlying Causes and Recurrence

• Demodex Treatment:

  • In patients with recurrent or multiple chalazia, particularly children, examination for Demodex infestation is crucial.
  • Comprehensive mite treatment can help prevent recurrences 6 7 8.
  • Options include tea tree oil lid scrubs and medications targeting mites.

• Managing Blepharitis and Meibomian Gland Dysfunction:

  • Ongoing eyelid hygiene, sometimes with topical or oral anti-inflammatory medications, is important to reduce recurrence 1 6.

Choosing the Best Treatment Approach

• Small, recent chalazia:
  • Start with conservative management and monitor closely.
• Medium or non-resolving after several weeks:
  • Consider intralesional steroid injection or, if appropriate, oral probiotics as adjuncts.
• Large, chronic, or vision-threatening chalazia:
  • Surgical incision and curettage.
• Recurrent/multiple or in children with visual symptoms:
  • Evaluate and treat for Demodex and underlying gland dysfunction.

Patient satisfaction is high with both conservative and surgical treatments, with nurse-led procedures shown to be safe and cost-effective 9.

Conclusion

Chalazia may seem like simple eyelid bumps, but their effects can be far-reaching—especially in children and those with recurrent disease. Prompt recognition, understanding the diverse causes, and a tailored, evidence-based treatment approach can minimize discomfort, prevent complications, and reduce recurrence.

Key Takeaways:

• Chalazia present as painless eyelid lumps but can cause discomfort, visual changes, or recurrent symptoms 2 3.
• Types include deep and superficial (anatomic), single or multiple (number), and vary in size; pediatric cases often involve larger or multiple lesions 3 2 6.
• The main cause is gland blockage, but risk factors like Demodex infestation, blepharitis, rosacea, and poor hygiene play critical roles, especially in recurrence 5 6 7 1.
• Treatment should be stepwise: start with lid hygiene and warm compresses, escalate to steroids or surgery for persistent cases, and address underlying causes (e.g., Demodex) to prevent recurrence 4 9 10 11 12 13.
• Early intervention is vital in children to prevent visual problems such as astigmatism 2.

By understanding the full picture of chalazia, patients and clinicians alike can make informed decisions for effective, lasting relief.