Chalazion is a benign tumor–like seal (hailstone) in the thickness of the eyelid, developing against the background of blockage and chronic inflammation of the meibomian gland. Chalazion is manifested by the presence of a nodule and swelling on the eyelid, pressure on the eyeball, irritation of the membranes of the eye, sometimes suppuration and spontaneous opening. Diagnosis usually does not require additional instrumental studies and is based on an external examination of the eyelid. Treatment can be conservative (instillation of medicines, laying ointments, injections into the formation) or surgical (removal of chalazion).
Chalazion (from Greek – nodule, hailstone) is characterized by chronic proliferative inflammation of the eyelid around the meibomian gland, developing when its excretory canal is blocked and secretions accumulate in it. In clinical ophthalmology, disease is a widespread problem and makes up 7.4% of the total structure of the pathology of the eyelid. The disease can affect people of all ages, but it is more common among adults, mainly at the age of 30-50 years.
The cause of the development of chalazion is a blockage of the duct of the meibomian (sebaceous) gland of the eyelid. Often, the formation of chalazion occurs against the background of the preceding barley, especially in cases of incomplete cure or relapse of the latter. To the development of chalazion predispose:
- chronic blepharitis;
- oily skin;
- diabetes mellitus;
- gastrointestinal diseases (dysbiosis, biliary dyskinesia, chronic gastritis, enterocolitis).
Contributing factors may be stress, hypothermia, acute respiratory viral infections, hypovitaminosis, infection in the eye with violations of personal hygiene rules, incorrect handling of contact lenses.
The meibomian glands are located in the thickness of the cartilage, have a tubular structure and open with their outlet ducts to the inner surface of the eyelid. In each eyelid there are about 50-70 glands that produce the outer (lipid) layer of the tear film. The function of the meibomian glands is to keep the eyeball moist and prevent the evaporation of tears from the surface of the eye.
As a result of the obturation of the meibomian gland, the lipid secret formed has no outflow to the outside and accumulates in the lumen of the excretory duct. This mechanism leads to inflammation of the tissues around the gland, encapsulation of the focus and the formation of a benign nodular seal on the eyelid. Microscopically, the chalazion is formed by granulation tissue and a large number of epithelioid and giant cells.
With the development of chalazion, a dense rounded formation appears under the skin of the lower or upper eyelid. This nodule is located in the thickness of the cartilage, not soldered to the skin, painless on palpation. The formation is prone to slow increase and can reach a size of 5-6 mm. As the chalazion increases, it becomes noticeable from the skin, forming a swelling and a visible cosmetic defect. On the part of the conjunctiva, an examination reveals a site of local hyperemia with a central zone of grayish color. It is possible to form several chalazions simultaneously on the upper and lower eyelid.
In some cases, chalazion is accompanied by itching and lacrimation, increased sensitivity to touch. Growing chalazion can put pressure on the cornea, causing astigmatism and vision distortion. Undiscovered chalazion, existing for a long time, turns into a cyst with mucous contents.
The course of chalazion can be complicated by abscessing and the formation of phlegmon of the eyelid. With suppuration of chalazion, symptoms of inflammation appear: local redness of the skin, swelling, throbbing pain, softening of the nodule. A rise in body temperature and the development of blepharitis is possible. Chalazion can spontaneously open to the surface of the conjunctiva with the release of purulent secretions. In this case, a fistula is formed, around which granulations grow. The skin of the eyelids becomes dry, reddened, covered with dried crusts of the discharge.
Recognition of chalazion is performed by an ophthalmologist during an external examination of the modified eyelid. The main signs of formation are the detection of a seal in the thickness of the eyelids the size of a millet grain or a small pea, not soldered to the surrounding tissues. When the eyelid is turned out, there is a local hyperemia of the conjunctiva. When moving, the affected eyelid lags behind the healthy one and makes blinking movements less often.
Carrying out instrumental diagnostics with chalazion, as a rule, is not required. Recurrent and fast-growing chalazions require differential diagnosis with adenocarcinoma of the meibomian gland. For this purpose, it may be necessary to conduct a histological examination of the biopsy of the formation.
Treatment of chalazion
Conservative methods are used in the early stages of chalazion. Instillation of disinfecting eye drops, laying mercury ointment behind the eyelid are prescribed. Dry thermal compresses, UHF therapy, massage of the eyelid and clogged gland can be used for the treatment of chalazion. A contraindication to thermal procedures is inflammation of the chalazion, since warming up can contribute to the spread of inflammation to nearby tissues with the development of an abscess or phlegmon of the eyelid.
Injections of corticosteroid drugs (betamethasone, triamcinolone) into chalazion have a good therapeutic effect. Corticosteroids are injected into the chalazion cavity with a thin needle and lead to gradual resorption of the neoplasm.
Radical treatment is performed surgically. The operation is outpatient, performed under local anesthesia through a transconjunctival or skin incision. During the operation, the chalazion is husked together with the capsule. When a fistula is formed, an operative incision is made along its entire length, after which the altered tissues are excised. After removing the chalazion, stitches are applied to the eyelid, and a tight pressure bandage is applied to the eye. In the postoperative period, the use of anti-inflammatory eye drops or ointments is recommended for 5-7 days.
An alternative to the classical surgical method is the laser removal of chalazion. In this case, the capsule is dissected with a laser, the contents of the chalazion are removed, followed by evaporation of the capsule by laser radiation. Laser removal of chalazion is less traumatic, does not require suturing and eliminates the recurrence of the disease. To prevent injury to the cornea by a postoperative scar for several days, the patient is recommended to wear a soft contact lens.
Prognosis and prevention
The outcome of the disease is usually favorable. After incomplete removal of the chalazion capsule, a relapse of the disease is possible. To prevent the development of chalazion, it is necessary to carry out a full volume of treatment for meibomyitis, blepharitis, compliance with hygiene requirements when using contact lenses, increasing the overall reactivity of the body.