GPAtlas🧭 When to suspect
Suspect a chalazion (meibomian cyst) when a patient presents with a small, firm, painless lump within the body of the eyelid that has developed insidiously over weeks. It arises from a blocked meibomian gland – one of the modified sebaceous glands in the tarsal plate – which ruptures and spills lipid into the surrounding tissue, provoking a sterile lipogranulomatous inflammation. Crucially, a chalazion is not an infection.
The whole consultation turns on one distinction: separating this chronic, benign, sterile lump from an acute hordeolum (stye), and recognising the rare lesion that masquerades as a “recurrent chalazion” but is in fact a malignancy. Most chalazia resolve with simple home measures; the clinical skill is knowing the small group that needs referral.
| Feature | Chalazion (meibomian cyst) | Hordeolum (stye) |
|---|---|---|
| Cause | Blocked meibomian gland → sterile lipogranuloma | Acute bacterial (usually staphylococcal) infection |
| Onset | Gradual, over weeks; chronic | Acute, over days |
| Pain | Usually painless and non-tender | Painful, red and tender |
| Location | Within the tarsal plate, away from the lid margin | At the lid margin (lash follicle or meibomian gland) |
| First-line treatment | Warm compresses and massage; no antibiotic | Warm compresses; antibiotic only if spreading |
Raise suspicion in anyone with a slowly enlarging eyelid nodule, and particularly where there is associated blepharitis, meibomian gland dysfunction, rosacea or seborrhoeic dermatitis. Recognised predisposing factors also include diabetes and pregnancy. The upper lid is affected more often than the lower, simply because it holds more meibomian glands.
Source: College of Optometrists
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