| Refractory to conservative/medical therapy |
| Multiple symptomatic chalazia |
| Interference with vision/amblyogenic |
| Recurrence/concern for neoplasm and need for biopsy |
| Assessment for madarosis, eyelid margin ulceration, or conjunctival hyperemia to suggest neoplasm |
| Fitzpatrick skin type (for adjunct steroid injection) |
| Photographic documentation of lesion |
| History of any prior skin malignancies |
Introduction
Chalazia are very common eyelid disorders and are seen in all ages with a higher predilection in patients with ocular rosacea and chronic blepharitis. A chalazion results from obstruction of a meibomian gland associated with focal inflammation of the eyelid. The obstructed meibomian gland secretions accumulate within the tarsal plate and surrounding tissues causing local erythema and discomfort.
The mainstay of chalazion treatment is medical management consisting of eyelid hygiene and warm compresses. Patient compliance with conservative management is essential for success. Topical or injected steroids may improve the lipogranulomatous component of chalazia but with persistent, non-resolving lesions, incision and drainage may be indicated. In children, persistent and large chalazion with associated pyogenic granuloma formation may obstruct the visual axis and/or induce anisometropia potentially causing amblyopia. Chronic, unilateral chalazion may be a masquerade syndrome for sebaceous cell carcinoma and a high index of suspicion should be maintained. A full thickness eyelid biopsy is necessary for diagnosis in this case ( Chapter 43 ).
Surgical Technique
