Chalazion: Clinical Features and Treatment

Chalazion is a chronic proliferative inflammation of the eyelid margin around the meibomian gland and eyelid cartilage. The disease appears when the outlet channel of the gland is blocked and the secretory fluid accumulates in it. There are many glands in the thickness of the eyelid, the secret of which forms the lacrimal fluid. When the excretory duct of the meibomian gland is blocked, which produces a fat-like secret to lubricate the eyelids and keep tears on the surface of the eye, chalazion develops. Subsequently, with a blockage of the excretory duct, the secretion of the gland breaks into the surrounding tissues and an encapsulated formation develops. The article Changes in Meibomian Gland Morphology and Ocular Higher-Order Aberrations in Eyes with Chalazion examines the transformations caused by chalazion.

In the initial stages, the meibomian gland is stretched with the formation of a noticeable swelling on the eyelid. The greasy secret becomes denser, the chalazion increases in size and becomes more solid. Due to the pressure created by the neoplasm on the surrounding tissues, minor pains and discomfort in the eye may occur. When an infection is attached, there may be swelling and slight hyperemia of the eyelid over the neoplasm (Fukuoka et al., 2017). Sometimes, in the absence of therapy, the process of chalazion growth is complicated by intense inflammation. In this case, in addition to the fatty secretion, purulent exudate can accumulate in the capsule. It can lead to spontaneous leakage of its contents onto the outer surface of the eyelid or, more often, onto the cornea of the eye. In the first case, a fistula is formed, which is periodically opened and the contents of the gland come out. In the second case, in addition to the formation of a fistula, there is a possibility of infection spreading to the membranes of the eye. The chalazion increases, the skin in its area turns red and swells, and touching it causes acute pain.

The article reviews the study of seven male patients with a history of chalazion. They were examined to evaluate the changes in the meibomian gland and ocular HOA. It was found that such transformations as gland dropout and shortening occurred in eyes with chalazion (Fukuoka, et al., 2017). The progressive growth of chalazion can lead to the disfigurement of the eyelids, for example, fibrosis of the cartilage, followed by an inward twist of the eyelid, the appearance of uneven edges, and eyelid baldness. There are also, although quite rare, severe complications of chalazion, for example, preseptal cellulite, inflammation of the subcutaneous fat of the orbit. Such complications are mainly observed in patients prone to atopic, non-standard reactions of the body. Severe pain and lacrimation appear, body temperature rises, and vision is noticeably reduced. The skin around the eye becomes red, and the swelling increases.

Moreover, when the diameter of the neoplasm exceeds 5 mm, the eyelid chalazion not only irritates the membranes of the eye but also exerts constant pressure on them. In addition to itching, lacrimation, and flaking of the skin, such a large neoplasm can also affect visual acuity. It presses on the eyeball, which leads to increased eye pressure and blurred images. Also, chalazion can cause damage to the cornea with its subsequent thickening or clouding, which provokes a significant deterioration in vision (Fukuoka et al., 2017). The mechanical effect on the cornea, which the patient feels like a rolling ball, leads to constant pressure and a change in its shape. As a result of this, astigmatism develops: vision decreases, objects are bifurcated or seem to be twisted, a person begins to confuse letters.

Thus, a large chalazion, especially located in the center of the upper eyelid, can cause visual impairment. When the treatment is carried out not persistently enough, it can lead to shortening of the eyelids, smoothing of the edges, and eversion of them. Therefore, it is important to consult an ophthalmologist in time and start treatment to avoid complications. The principles of treatment are aimed at resolving the effect, eliminating symptoms, and reducing the activity of immune cells that form a purulent capsule.

Reference

Fukuoka, S., Arita, R., Shirakawa, R., & Morishige, N. (2017). Changes in meibomian gland morphology and ocular higher-order aberrations in eyes with chalazion. Clinical Ophthalmology (Auckland, NZ), 11, 1031.