A meibomian cyst, commonly referred to as chalazion, is a non-infectious inflammatory disease of the sebaceous glands on the eyelids that presents as an enlarging lump over the course of days or weeks without resolution to topical antimicrobial therapy. Acne rosacea and seborrheic dermatitis increase the risk for meibomian cysts. Blurred vision may be encountered with larger meibomian cysts, while pain is almost always absent. The diagnosis rests on clinical criteria, but because malignant tumors may have an identical clinical presentation, a histopathological examination is advocated.
Presentation
A meibomian cyst (also known as chalazion) arises when the outflow of the meibomian glands in the eyelids is blocked, leading to the accumulation of the secretions produced and the formation of a cyst [1] [2] [3] [4]. It is defined as a benign lipogranulomatous collection that develops from non-infectious causes, which is the crucial feature distinguishing it from a stye, which is formed because of a bacterial infection [4] [5] [6]. The clinical presentation is characterized by the appearance of a painless lump on the eyelid that grows over a period of days or weeks [1] [2]. The lump exhibits a variable degree of tenderness, swelling, and redness (depending on the stage) that often overlaps with the presentation of a stye, but all of the aforementioned signs eventually subside [1] [4]. Both upper and lower eyelids may be the location of a meibomian cyst, which can sometimes appear in multiple sites [4]. In some cases, the cyst may be large enough to induce mechanical ptosis or astigmatism, leading to symptoms such as blurred vision and deficits in the visual field [1] [4]. A cosmetic discomfort is also an important complaint and is often the main reason for a visit to the physician [4]. Several cutaneous disorders have been associated with an increased risk for meibomian cyst formation, including rosacea, seborrheic dermatitis, and blepharitis [1] [4].
Eyes
- Blepharitis
Blepharitis Blepharitis means inflammation of the eyelids. Blepharitis can be a troublesome and recurring condition with no one-off cure. [evidence.nhs.uk]
Overview What Is Blepharitis? What Is Blepharitis? Blepharitis is a chronic inflammation that affects the eyelids and the eyelashes, and it is one of the most common problems doctors see in their office. [healthcare.utah.edu]
However, chronic inflammation of the oil gland openings ( blepharitis ), predisposes to the development of a chalazion. Persistent blepharitis may result in recurrent chalazia. [aapos.org]
- Conjunctival Injection
Common signs of DES include conjunctival injection, decreased tear meniscus, photophobia, increased tear debris, and loss of corneal sheen found more commonly in the exposed interpalpebral fissure. [slideshare.net]
Workup
With a properly conducted physical examination and a meticulously obtained patient history, the initial diagnosis of a meibomian cyst can be easily made. The typical appearance of a lump on the eyelid without the presence of pain (mainly seen when a stye develops) is a hallmark of this clinical entity. Some patients report ineffective use of topical antimicrobials [1], which points to a non-infectious type of inflammation. Although the physician can clearly visualize the lesion and make a solid diagnosis based on physical findings only [1], some authors recommend further evaluation of the lump through histopathological methods [2] [3] [6]. The primary reason is that several tumors, particularly sebaceous cell carcinoma (carrying a mortality rate of 20% in the absence of an early diagnosis and up to 50% when tumor spreading occurs) have an identical clinical presentation [2] [3] [5]. Disruption of the skin and ulceration are suggested as signs indicative of a malignancy instead of a meibomian cyst [1], but they may not always be present. The identification of a lipogranulomatous content and multinucleated giant cells with an abundant white blood cell infiltrate are main findings on microscopy of meibomian cysts [6]. Noninvasive meibography, designed to evaluate the morphology of the meibomian glands, is a potentially useful procedure to discriminate between a chalazion and a sebaceous cell carcinoma [5].
Microbiology
- Microsporum
Giant Chalazion. 61 Lloyd M...Wasserman BN 30454715 2018 28 A case report of eyelid Merkel cell carcinoma occurring under treatment with nivolumab for a lung adenocarcinoma. 61 Lavacchi D...Mini E 30348121 2018 29 Eyelid tinea with blepharitis due to Microsporum [malacards.org]
Treatment
Marginal cost analysis was used to determine the cost of treatment. The outcome of treatment could be determined in 170 of the 217 visits. Conservative treatment was successful for 29% of cysts while surgical treatment was successful for 72%. [ncbi.nlm.nih.gov]
Conservative treatment took an estimated 10 minutes and cost £2.73 for nurse treatment and £2.67 for SHO treatment. [bjo.bmj.com]
A chalazion will often go away without treatment in a month or so. The first treatment is to place warm compresses over the eyelid for 10 to 15 minutes at least four times a day. [nlm.nih.gov]
Prognosis
The prognosis of Chalazion is usually excellent with adequate treatment Please find comprehensive information on Chalazion regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention, prognosis [dovemed.com]
A chalazion is usually a self-limiting condition with excellent prognosis. However, the patient is instructed to follow regular lid hygiene measures and control of meibomitis. Prognosis Prognosis is excellent. Jerry A. Shields, Carol L. Shields. [emedicine.medscape.com]
Outlook (Prognosis) Chalazia most often heal on their own. The outcome with treatment is excellent in most cases. Possible Complications Rarely, a chalazion will heal by itself but may leave a scar on the eyelid. [ufhealth.org]
Benign lesions such as papillomas, hordeolum, juvenile xanthogranuloma, and xanthelasma should be considered if appearance is not typical for chalazia. [7] Prognosis Prognosis is excellent for patients with chalazia. [ncbi.nlm.nih.gov]
Etiology
However, there may be times when an associated infectious etiology is suspected. If an infection is considered, tetracyclines are the antibiotics of choice. [ncbi.nlm.nih.gov]
Chalazion Definition: Firm, nontender nodular lesion of the eyelid resulting from obstruction and subsequent chronic granulomatous inflammation of a Zeis or meibomian gland. http://dro.hs.columbia.edu/chalazion.htm Etiology: Normally, sebaceous meibomian [pedclerk.bsd.uchicago.edu]
Etiology Chalazia occur after gland blockage, which can be associated with the following: Poor lid hygiene (the precise causal role has not yet been established) Acne rosacea High blood lipid concentrations (possible risk from increased blockage of sebaceous [emedicine.com]
Epidemiology
Key points Description Benign granuloma of oil-producing gland of the eyelid Cause Blockage of gland duct by thick oil or keratin causes gland rupture and lid inflammation Epidemiology Common lid lesion associated with blepharitis at any age Clinical [pulsetoday.co.uk]
Epidemiology [ 1, 4 ] Chalazia are the most common of all lid lumps. They can occur at any age. [patient.info]
Meanwhile, recent epidemiological survey showed MGD is a major cause of dry eye. In the MGD clinic, we thoroughly examine both subjective symptoms and objective findings for accurate diagnosis. [ophthal.med.keio.ac.jp]
Epidemiology United States and international statistics Chalazia are common, but their exact incidence and prevalence in the United States are not known. Data about the worldwide prevalence or incidence of chalazia are also unavailable. [emedicine.com]
Pathophysiology
Pathophysiology Chalazia form when lipid breakdown products, possibly from bacterial enzymes or retained sebaceous secretions, leak into surrounding tissue and incite a granulomatous inflammatory response. [2]. [emedicine.com]
Prevention
Prevention Cleansing the eye area every day can help prevent a chalazion from developing or recurring. Using eyelid scrubs or premoistened cleansing wipes to keep the oil glands from becoming blocked. [medicalnewstoday.com]
PREVENTION Avoiding exposure from ultraviolet rays can prevent the formation. POST-TREATMENT AFTER SURGERY If the pterygium is removed by surgical procedure it is required to use eye drops for about 10 days after surgery. [lassjol.hu]
Is there anything I can do to prevent cysts? Some people have a predisposing lid problem (Blepharitis) if you have blepharitis the Nurse will advise you on how to clean your lids, to prevent further cysts. Written by Margaret Gray. [nhsggc.org.uk]
How to prevent chalazion cysts The best way to prevent the development of chalazion cysts is to keep your eyelids clean and free of irritants. Wash your hands often to prevent dirt from being transferred to your eyelid when you rub your eyes. [belmarrahealth.com]
References
- Arbabi EM, Kelly RJ, Carrim ZI. Chalazion. BMJ. 2010;341:c4044.
- Ozdal PC, Codère F, Callejo S, Caissie AL, Burnier MN. Accuracy of the clinical diagnosis of chalazion. Eye (Lond). 2004;18(2):135-138.
- Al-Mujaini A, Sabt B, Al-Hadabi I. It is not chalazion. Oman J Ophthalmol. 2013;6(1):63-69.
- Gilchrist H, Lee G. Management of chalazia in general practice. Aust Fam Physician. 2009 May;38(5):311-314.
- Nemoto Y, Arita R, Mizota A, Sasajima Y. Differentiation between chalazion and sebaceous carcinoma by noninvasive meibography. Clin Ophthalmol. 2014;8:1869-1875.
- Ahuja S, Rao VA, Kumar P, Rajesh N, Srinivasan R. Sebaceoma of the Conjunctiva Presenting as a Chalazion. Indian J Dermatol. 2014;59(5):521-522.