Managing Chalazion: Expert Advice for Sore and Inflamed Eyelids

QUESTION: "Hi. Having recently seen a social media post about how to treat and drain a chalazion, I bought an eye brush and roller and began following the protocol. After a few days of repeating the protocol, my eyelid is sore and inflamed, but the chalazion does not appear to be draining. Also, there doesn't seem to be an 'entry' point on the eyelid as indicated in the post. I wonder if you could advise on the best course of treatment based on the above."

 

Hello, I'm Dr. Tanya Gill, OD, and I’m going to troubleshoot this very common question. Here's a checklist to review to make sure you're cleaning your chalazion properly.

 

 

 

1. Self Diagnosis vs. Real Diagnosis

Make sure it's the right diagnosis: chalazion. There are eyelid presentations that can seem like a chalazion, but are not. Get a proper diagnosis from your optometrist. For example, a common error is an eyelid that is actually having a herpetic flare up that disguises to the untrained eye as a 'chalazion flare up.' Herpetic flare ups DO NOT respond well to heat, cold, and or scrubbing - in fact it usually gets worse with temperature change and even scrubbing which the eye will perceive as a mild trauma.

2. Incomplete Protocol

The Meibomian Gland Dysfunction (MGD) Cleansing System consists of 4 items: Focused Eye Roll, Eyelid Margin Scrub Brush, Tea Tree Eyelid & Eyelash Cleansing Oil, and Tea Tree Eyelid & Eyelash Foaming Cleanser. The steps are clear: Roll, Scrub, and Wash Off. Using the tools without the cleansers doesn't work. Using the cleansers without the tools doesn't work either. 

3. Daily Use Only

Draining a chalazion takes time. Rolling more, scrubbing more, washing more - doesn't make results come faster. It just makes the eyelid sore and inflamed faster. Just once a day before bedtime  to start. If the eye feels good, then increasing just the Focused Eye Roll step can benefit chalazion draining. 

4. It's a Marathon Not a Race

In general (emphasize IN GENERAL), the amount of time my patient has had their chalazion = the amount of time it will take for their chalazion to properly drain-clean. So if they have had a chalazion for 4 months, it's gonna take about 4 months. 

5. No Exit Site 

If there is no exit site after using MGD Cleansing System after approximately 10 days, here is what to do next. 

1. 1. verify the diagnosis with your optometrist;
   2. for a stubborn chalazion, ask your optometrist to create the exit site for you;
      
   3. for a stubborn chalazion - some cannot be helped if it's been self-sealed by the surrounding ocular tissue. Here steroid injection, energy device (i.e. Intense Pulsed Light), or surgery may be other options. 

 

WHAT MAKES A STUBBORN CHALAZION

Of course this will vary case by case, but in general these are the line items that run through my mind when evaluating a chalazion:

• • Soft vs Hard. Assuming size is the same, a hard chalazion is more stubborn.
  • Small vs Large. Not as important as firmness, but in general large, soft chalazion are easier to clean. A small, harder chalazion takes longer to clean. 
  • Age. Chalazion less than 4 weeks old are super easy to clean. Conversely, older than 4 months become more stubborn. Catching and using MGD Cleansing System ASAP increases success.
  • Location. The further the distance from the eyelid margin will take more time to clean. Higher the location for the upper eyelid, and lower the location for the lower eyelid is more stubborn to clean.

When I'm Highly Suspicious

When there is more pain, discomfort, soreness, and/or change in vision, I ALWAYS see the patient for an office visit. No need to miss these potential diagnoses (listing the most common):

• • Preceptal cellulitis - need oral antibiotics;
  • Orbital cellulitis - life threatening, need IV antibiotics;
  • Ocular herpes - can mimic a chalazion eyelid; need to change the eye care routine & prescribe oral and topical prescription meds;

Remember, every case is unique, and while the above guidelines can help, they are not a substitute for a personalized consultation in real life with your optometrist.

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About Dr. Tanya Gill, OD:

Dr. Tanya Gill is the Founder of We Love Eyes and a dedicated optometrist with 20+ years of experience in eye care. Her professional guidance is designed to help you achieve the best eye health possible. For more advice and a personalized eye care routine, see your optometrist and visit We Love Eyes.