Chalazion Workup

Updated: Nov 03, 2022
  • Author: Jean Deschênes, MD, FRCSC; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Approach Considerations

The diagnosis of chalazion is usually clinical and often does not require further workup. [1] The healthcare provider should be certain that the eyelid lesion is a sterile inflammation that will resolve with limited intervention. Recurrent symptoms or persistent lesions should prompt further investigation.

Recurrent chalazia, especially if they recur despite previous successful drainage in the same exact location, must be considered potentially malignant and biopsied. Some specialists recommend biopsy and drainage of all chalazia, whether primary or recurrent.


Laboratory Studies

The material obtained from a chalazion shows a mixture of acute and chronic inflammatory cells, as well as large, lipid-filled, foreign body−type giant cells. Lipid analysis may reveal fatty acids with long carbon chains that result in an increased melting point. This finding possibly accounts in part for the blockage of secretions.

Viral and bacterial cultures may help pinpoint an infectious etiology but tend to have a low yield. Although bacterial culture findings are often negative, S aureus, Staphylococcus albus, or another cutaneous commensal organism may be isolated. Propionibacterium acnes may be present in the glandular contents. Appropriate selection of topical or systemic antibiotics is best directed by culture and sensitivity results, particularly in recalcitrant, chronic, or recurrent cases.

Fine-needle aspiration cytology of atypical chalazia can confirm a diagnosis and exclude malignancy. It is best performed by an eye specialist.


Other Studies

Visual acuity testing and visual field testing should also be considered as appropriate. It is essential to evert the superior tarsus whenever tolerable by the patient.


Histologic Findings

Histologic examination reveals a chronic granulomatous reaction with numerous lipid-filled, Touton-type giant cells. Typically, the nuclei of these cells are located around a central foamy cytoplasmic area that contains the ingested lipid material. Other typical mononuclear cells, including lymphocytes or macrophages, may also be found at the periphery of the lesion. The granulomas of chalazia may also stain positively for C. acnes-specific monoclonal antibody (PAB antibody). 

In the event of a secondary bacterial infection, an acute necrotic reaction with PMNs may ensue.

Destruction of the fibrocartilage of the tarsal plate may be evident.

Foreign bodies, such as embedded parts of polymethyl methacrylate [PMMA] contact lenses in the tarsal plate, have also been encountered in cases of chronic chalazia.


Imaging Studies

Infrared photographic imaging of the meibomian glands can demonstrate abnormally dilated glands through the everted lid, as well as inspissated secretions.

Point of service clinical imaging of meibomian gland architecture is readily available from Tear Science (LipiView and LipiScan), as well as Oculus (Keratography 5-M).