Do chalazion recur?
I am often asked by patients whether their chalazion, once it has been incised and curetted if it will come back again. This is a challenging question because Chalazia occur in blocked meibomian glands and represent the body’s inflammatory response to the blockage with the oil meibum build up. I usually say to them that the actual chalazia that I am draining are not likely to come back. However, that chalazion is sitting amidst a whole load of meibomian glands which are inflamed, sluggish, partly blocked which can themselves form new chalazia.
Today I had a young lady come into the clinic, who I had previously incised and curetted one chalazion in her left upper eyelid and two in her right lower lid. They had been quite large. She was concerned that three weeks later there was still some swelling and wondered if the chalazion had come back?
Meibomian Gland Dysfunction
I noted that she had about a third of eyelids severely affected by Meibomian Gland Dysfunction, which is a form of blepharitis. She had used her postoperative Chloramphenicol four times a day for a week, and after that, she had been doing her eyelid healing, massage and cleaning twice a day, but had not been on any eye medication apart from lubricant eyedrops. She noticed that there was still a little bit of redness present and fullness of the eyelids. She had formed new granulomas next to where she has had the chalazion treated surgically.
The dilemma then was whether to do further surgery, to scrape the granulomas off the conjunctival surface which were next to the area where the chalazia had been incised, or to treat them medically in the first instance. We had a long discussion and opted for medical treatment as it is never comfortable to have repeat chalazion surgery as close as three weeks after the previous surgery, especially when everything is so inflamed.
I put her on a mixture of steroid antibiotics in reducing doses for four weeks warning her of the possible complications and that we can consider surgery or even an injection of steroid into the eyelid at the next visit if the granuloma has not gone away. I think to balance we will probably go for injection of steroid into the eyelid at the next visit if the early chalazia are not fully dampened down using eyedrops and ointment.
In conclusion, the answer to my original question, can chalazia recur, is no and yes. The chalazion drained does nor recur, but other chalazia can form in adjacent active areas of Meibomian Gland Dysfunction. A chalazion “recurs” usually adjacent to the original chalazion, the reason being is that one chalazion is just a single manifestation of a longer part of the lid which is affected by meibomian gland dysfunction and represents an inflammatory response to the rather thick oil which is not draining well.
Therefore, it is important to treat the underlying Meibomian Gland Dysfunction to prevent the chalazion recurring in another spot.