Meibomian Cyst (Chalazion)

Sterile, chronic, inflammatory granuloma of the eyelid caused by a foreign body reaction to sebum within a meibomian gland

Aetiology

The primary etiologic factor in chalazion formation is Meibomian gland dysfunction, leading to glandular obstruction. Predisposing factors include:
  • Chronic blepharitis
  • Rosacea
  • Seborrheic dermatitis
  • Poor eyelid hygiene
  • Recurrent hordeolum
  • Dyslipidemia (association reported)
  • Chronic contact lens use (indirect association)

Pathophysiology

  • The meibomian glands (located in the tarsal plate) are a set of glands that run along the eyelid margin
  • They produce a lipid secretion which provides the lipid layer of the tear film
  • Obstruction of the gland duct causes the gland to enlarge and to rupture, releasing the accumulated lipid contents into the surrounding eyelid soft tissue
  • This triggers an inflammatory reaction against the lipid content which subsides with time
  • Consequently, the meibomian cyst often becomes painless and non-tender

Clinical presentation

Symptoms

  • Painless eyelid swelling
  • Cosmetic concern
  • Blurred vision if large enough to induce astigmatism
  • Mild eyelid heaviness

Signs

  • Firm, well-circumscribed nodule within the tarsal plate
  • Overlying skin freely mobile
  • No significant erythema or tenderness
  • Conjunctival surface may show localized erythema or granulomatous tissue
  • Usually unilateral, but may be multiple or bilateral
notion image

Management

  • Warm compresses 4x/day for 10-15 minutes for several weeks
  • Intralesion corticosteroid → triamcinolone acetate 40mg/mL 0.1-0.2 mL
  • Most meibomian cysts resolve spontaneously or with conservative management, although this may take weeks or months
  • Management of any co-existing risk factors to reduce risk of recurrence