A small lump in your eyelid that is not a stye, not dangerous, and almost always treatable at home. Here is everything you need to know.
A chalazion is a small, firm lump that forms inside the eyelid when one of its oil-producing glands gets blocked. Most people notice it when they feel something new while touching their eye, or spot a bit of swelling in the mirror. It sits inside the lid like a small pea. Unlike a stye, it usually doesn’t hurt once it’s settled. Knowing why it forms and what to do about it makes the whole thing considerably less stressful, and for most people, the answer is simpler than they expect.
Overview
- A chalazion forms when a meibomian gland in the eyelid gets blocked and the oil inside builds up into a cyst
- Unlike a stye, it is not an infection and develops slowly over days to weeks
- Most chalazia resolve with warm compress (eyelid anatomy context) treatment done four times a day
- If it hasn’t gone in four to six weeks, a steroid injection or a small incision under local anaesthetic sorts it in most cases
- People with blepharitis or rosacea tend to get them more often. Treating the underlying condition reduces how often they come back
- A chalazion is not contagious
Chalazion vs Stye: What Is the Difference?
Patients often come in not sure which one they have. Both cause a lump on the eyelid, but they are different things. Here is the simplest way to tell them apart:
- Usually painless once formed
- Develops slowly over days to weeks
- Firm and round, sits deep in the lid
- Not infectious, no bacteria involved
- Caused by a blocked meibomian gland
- Does not usually need antibiotics
- Painful, tender, often red
- Comes up quickly, within a day or two
- Sits near the lid edge, often at a lash root
- Caused by a bacterial infection
- May need antibiotic ointment
- Can occasionally turn into a chalazion
Why Does a Chalazion Form?
The meibomian glands
Your eyelids contain around 25 to 40 meibomian glands in each lid. They produce a thin oil that sits on top of your tear film and stops your tears evaporating too quickly. Think of them as tiny oil dispensers, with their openings running along the inner edge of the lid.
When one gets blocked, usually by thickened or hardened secretion, the oil backs up and forms a small cyst. The body reacts to the trapped material with inflammation. That is what causes the lump. Over time the redness and tenderness settle, leaving the firm, painless nodule most people recognise as a chalazion.
Who gets them more often?
Anyone can get a chalazion. They are more common in people with blepharitis or meibomian gland dysfunction, conditions where gland openings are chronically inflamed and prone to blocking. Rosacea is strongly linked to both. If you keep getting chalazia and you also have rosacea, treating the rosacea often cuts how often the eye problem comes back.
Chalazia are more common in adults than children. Hormonal changes and certain eye products have been reported as triggers, though the evidence for these is thinner.
Symptoms
A chalazion is usually a firm, round lump somewhere within the eyelid. A few things are worth knowing:
- In the early stages it may be tender, with the surrounding lid slightly red and swollen
- Once it matures, it settles into a painless, rubbery lump you can feel clearly even if it’s barely visible from outside
- It can be on either lid, and on the outer skin side or the inner conjunctival surface
- A large chalazion pressing on the cornea can temporarily blur or distort vision. This goes away once the chalazion is treated
- You can have more than one at a time, and they can recur in the same spot or somewhere new
Treatment
Most chalazia respond well to treatment. The approach depends on how new it is, how large, and whether conservative measures have already been tried.
Warm compresses
Five to ten minutes against the closed eyelid, four times a day. The heat softens the thickened secretion and makes drainage more likely. A heated eye mask beats a flannel because it stays warm longer. Many chalazia, particularly smaller ones, clear within four to six weeks. After each session, gentle massage toward the lid edge helps.
Eyelid hygiene
A gentle lid scrub or commercial lid wipe along the lash margin once or twice daily removes debris and reduces the bacterial load around the gland openings. Especially important if you have underlying blepharitis. Keep this routine going long-term and it cuts how often chalazia come back.
Steroid injection
If things haven’t shifted after four to six weeks, a small corticosteroid injection directly into the lump is usually next. Done in the clinic under local anaesthetic, takes a few minutes. About 75 to 80 percent of persistent chalazia respond to a single injection, with the lump shrinking over two to four weeks. A second injection is sometimes needed for larger ones.
Incision and curettage
For chalazia that don’t respond to injection, or that are very large, a small procedure is the most reliable option. A tiny incision through the inner surface of the eyelid (no visible skin scar) and the contents are scooped out. Five to ten minutes under local anaesthetic. The lid will be bruised and swollen for a few days, but recovery is usually straightforward.
If Your Chalazion Keeps Coming Back
Some people get chalazia repeatedly. When that happens, it almost always means there’s an underlying meibomian gland problem that hasn’t been properly addressed. Just treating each one as it appears without tackling the root cause leads to a frustrating cycle.
More than one or two a year? The most useful step is a proper assessment of your meibomian gland health. A consistent daily routine of warm compresses and lid cleaning, plus treatment of any associated rosacea or blepharitis, makes a real difference. Some patients benefit from in-office treatments like thermal pulsation or intense pulsed light therapy when home treatment isn’t enough.
In adults over 40 with a recurring or unusual-looking chalazion that isn’t responding to treatment, the excised material should be sent for histological examination. Very rarely, what looks like a chalazion turns out to be a sebaceous gland carcinoma. Low likelihood, but an important check in the right circumstances.
See an Ophthalmologist Promptly If You Notice
- The lump is growing rapidly, very painful, or redness is spreading beyond the eyelid
- Fever alongside a swollen, red eyelid
- The lump is irregular in shape, bleeds easily, causes lash loss, or has been growing for more than three months without responding to treatment
- Vision is noticeably reduced or distorted
- A chalazion that has burst through the skin leaving a persistent red area
Most chalazia are completely harmless. The signs above suggest something that needs a closer look: infection, a complication, or rarely something else entirely. When in doubt, a brief review gets you the right answer quickly.
Questions People Actually Ask About Chalazia
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How long does it take to go away?
With warm compresses four times a day, many chalazia clear in four to six weeks. Start early, before the cyst firms up and becomes fibrous. That gives you the best chance. Left for more than two or three months without treatment, it’s unlikely to clear on its own. The good news is that a steroid injection or drainage procedure is quick and works well when it gets to that point.
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Can I pop it myself?
Please don’t. Squeezing or puncturing a chalazion at home risks infection, scarring, and making everything worse. The contents are inside a fibrous cyst wall, and they won’t drain with external pressure. If it needs draining, your ophthalmologist (who uses a slit lamp) can do it properly. It takes a few minutes and is genuinely not as bad as it sounds.
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Is it contagious?
Not at all. A chalazion is a sterile cyst, not an infection. There’s no risk of passing it to anyone else. This sets it apart from a stye, which is bacterial and warrants a little more care around hand hygiene while active.
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It came back in exactly the same spot. Why?
Usually means the original cyst didn’t fully resolve, or that particular gland is prone to blocking because of underlying blepharitis or meibomian gland dysfunction. If it keeps recurring in exactly the same place despite treatment, surgical excision with histological examination is the right move. That’s the step that rules out anything more serious.
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Can it affect my vision?
Small and medium chalazia don’t affect vision. A large one pressing on the cornea can temporarily cause astigmatism, meaning blurry or slightly distorted vision. It clears once the chalazion is treated. In young children this is worth treating more promptly, since persistent astigmatism during the critical years of visual development can contribute to amblyopia.
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Do I need time off work after the drainage procedure?
Most people take one day off and are back at a desk the next. The procedure is done under local anaesthetic and takes five to ten minutes. Afterward the lid is typically swollen and bruised for a few days. Avoid dust, swimming, and heavy lifting for about a week. No stitches, no visible scar.
If you would like to learn more, the American Optometric Association’s chalazion page offers a clear overview of symptoms, causes, and treatment.
A chalazion is a chronic sterile lipogranuloma of the eyelid, resulting from retained secretion and subsequent inflammatory reaction around a blocked meibomian gland (tarsal gland) or, less commonly, a Zeis or Moll gland. It is one of the most common eyelid conditions seen in ophthalmic practice. The distinction from an acute hordeolum (stye) is clinically important: a hordeolum is an acute bacterial infection (staphylococcal in most cases), tender, red, and self-limiting; a chalazion is a chronic, non-tender, firm cystic lesion that typically requires intervention to resolve. Most chalazia respond to conservative management; those persisting beyond 4-6 weeks warrant incision and curettage (I&C). Recurrent chalazia in the same site in an adult over 40 must raise suspicion for sebaceous gland carcinoma of the eyelid.
Clinical Overview: Chalazion
- Pathology: Lipogranulomatous inflammation from meibomian gland obstruction and rupture. Stagnant lipid secretion leaks into surrounding tarsal tissue, triggering a foreign-body granulomatous response (epithelioid histiocytes, giant cells) around the lipid material. No bacteria present in the mature chalazion , unlike hordeolum.
- Clinical features: Firm, non-tender, smooth lid lump, typically in the mid-tarsus. Overlying skin freely mobile. Conjunctival aspect may show a yellow-white lipid deposit through the everted lid. Ptosis from mass effect if large. Corneal flattening (with-the-rule astigmatism) from large chalazion pressing on the superior cornea.
- Conservative treatment: Slit-lamp everted lid examination and warm compress (40-45°C, 5-10 minutes, 3-4×/day) followed by lid massage over 4-6 weeks. Lid hygiene to reduce the meibomian gland obstruction that produced it. Resolves spontaneously in approximately 50% of cases within 4 weeks.
- Intralesional steroid: Triamcinolone acetonide 10-20 mg/mL, 0.1-0.2 mL injected directly into the chalazion, typically via the posterior (conjunctival) approach. Success rate approximately 70-80% for single injection. Risk of depigmentation (significant in dark skin , prefer I&C), globe perforation (rare), and raised IOP.
- Incision and curettage (I&C): Standard definitive treatment for non-resolving chalazia. Local anaesthetic (lidocaine 2% with adrenaline), clamp application, vertical incision through the posterior conjunctival surface (avoids skin scar), curettage of lipid contents and capsule. Success rate >90% for single lesion.
- Recurrence and carcinoma: Any chalazion recurring at the exact same site in a patient over 40 years must be biopsied at the time of I&C to exclude sebaceous gland carcinoma. Send ALL chalazion specimens for histopathology as routine , OSSN and SGC have been missed by clinicians who did not send tissue.
Pathophysiology
The meibomian glands (approximately 25-30 in the upper lid, 20-25 in the lower) are modified sebaceous glands embedded in the tarsal plate. They secrete lipid (meibum) through ductal orifices at the posterior lid margin, contributing the outer lipid layer of the tear film. Obstruction of a gland orifice , from hyperkeratinization of the duct epithelium, inspissated meibum (often driven by posterior blepharitis), or Demodex infestation , causes retained secretion to accumulate under pressure.
The duct eventually ruptures, releasing lipid material into the surrounding tarsal stroma. This triggers a type IV (T-cell mediated) granulomatous reaction: epithelioid macrophages, lymphocytes, and multinucleate giant cells form a wall around the lipid deposit. This is the chalazion , a lipogranuloma, not an abscess. The absence of bacteria in the mature chalazion explains why antibiotic treatment has no role once the hordeolum phase has resolved. The granulomatous capsule is what the curette removes at I&C.
Clinical Assessment and Differential Diagnosis
Examination: Inspect the external lid surface and evert both lids to examine the tarsal conjunctiva. A chalazion appears as a firm, smooth, well-demarcated swelling within the tarsus on the posterior lid surface, often with a yellowish lipid centre visible through the conjunctiva. External chalazia (pointing anteriorly through the orbicularis) are less common. Assess for associated blepharitis and meibomian gland dysfunction , the underlying cause in most recurrent chalazia.
Differential diagnosis , what is not a chalazion:
- Hordeolum (external/Zeis stye): Acute, tender, red, points toward the lash line. Usually self-limiting with warm compresses and topical antibiotic.
- Internal hordeolum: Acute meibomian gland abscess , more tender and diffuse than chalazion, may point internally. Treat with oral antibiotics (flucloxacillin or cefalexin) if cellulitic spread.
- Sebaceous gland carcinoma (SGC): Can mimic a chronic chalazion or blepharitis. Key red flags: recurrence in the same site, loss of lashes (madarosis) over the lesion, diffuse lid thickening. SGC carries pagetoid spread along the conjunctival epithelium that may not be visible on external inspection. Biopsy any atypical or recurrent chalazion.
- Pyogenic granuloma: Soft, vascular, rapidly growing pedunculated lesion, typically after previous I&C or trauma. Bleeds easily. Excise completely.
- Orbital dermoid cyst: In children , smooth, firm, non-tender lump usually at the superolateral orbital rim. Does not transilluminate. Ultrasound differentiates from chalazion.
Treatment in Detail
Conservative management: Warm compresses liquefy the stagnant meibum, improving drainage through the gland duct. The critical technique: the compress must maintain 40-45°C for the full duration (a hot flannel cools within 2 minutes , use a dedicated microwaveable mask or the EyeBag). Lid massage after the compress promotes expression. Lid hygiene (Blephaclean wipes) reduces the bacterial lipase activity that degrades meibum and worsens the cycle. Many chalazia resolve with 4-6 weeks of consistent twice-daily routine, avoiding any invasive intervention.
Intralesional triamcinolone technique: Instil topical anaesthetic. Use a 26-30G needle on a 1 mL syringe. Approach from the posterior (conjunctival) surface of the everted lid wherever possible , avoids skin depigmentation. Inject 0.1-0.2 mL of triamcinolone 10-20 mg/mL directly into the chalazion cavity. Gentle pressure post-injection. Effects over 2-4 weeks. A second injection at 4 weeks is appropriate if partial response. Anterior (transcutaneous) injection should be used in lower lid chalazia where posterior approach is awkward, but warn about depigmentation risk particularly in Fitzpatrick IV-VI skin types.
I&C Procedure
Technique: Topical antibiotic and anaesthetic drops. Lidocaine 2% with 1:200,000 adrenaline injected subcutaneously at the posterior lid surface (2-3 injection points around the chalazion). Chalazion clamp applied to evert the lid and isolate the lesion. Vertical incision through the tarsal conjunctiva (parallel to the meibomian glands , vertical incision avoids transecting multiple glands). Curette the lipid contents and granulomatous capsule thoroughly. Remove the clamp and apply pressure for 2-3 minutes. Topical antibiotic for 1 week post-procedure.
Do not make a horizontal incision through the posterior lid surface , this transects multiple meibomian glands and increases the recurrence risk. Vertical incision preserves adjacent glands.
Histopathology submission: every chalazion excision specimen should be sent, particularly in adults over 40. The risk of missing a SGC is small but the consequence is severe , SGC spreads intraepithelially (pagetoid) and can metastasize to regional lymph nodes.
Clinical Decision Points
- New chalazion, present 3 weeks, tender: Conservative management first , warm compresses, lid hygiene. Most resolve without intervention. Reassess at 4-6 weeks before offering I&C or steroid injection.
- Large chalazion causing ptosis or corneal astigmatism: Earlier intervention , steroid injection first if size is moderate; I&C if large, hard, or previously failed steroid. Astigmatism from chalazion pressure typically resolves within 4-6 weeks after removal.
- Recurrent chalazion in same location, patient over 40: Biopsy at time of I&C. Do not attribute to “blepharitis alone” without histopathological exclusion of SGC. Ask about ipsilateral dry eye and unilateral madarosis.
- Multiple simultaneous chalazia, bilateral: Indicates severe posterior blepharitis/MGD. Treat the underlying condition with doxycycline 50 mg daily for 8-12 weeks, intensified lid hygiene, and meibomian gland expression. Treating individual chalazia without addressing the underlying MGD leads to recurrence.
- Child with chalazion, conservative management failing: GA is required for I&C in most children below age 8-10. Steroid injection under topical anaesthetic is often better tolerated than I&C in children and should be tried first. Involve paediatric liaison if GA is being considered.
When to Escalate
- Acute preseptal or orbital cellulitis from spreading hordeolum , IV antibiotics, CT orbit if post-septal involvement suspected
- Rapidly growing lid mass with madarosis not responding to chalazion treatment , same-week biopsy to exclude SGC
- Vision-threatening corneal exposure from large chronic chalazion and complete ptosis in a child , amblyopia risk; urgent I&C under GA
Sebaceous gland carcinoma of the eyelid has a mortality rate of approximately 5-10% from regional and distant metastasis if diagnosed late. The window between early local disease (where lid-sparing excision is curative) and advanced pagetoid spread (requiring exenteration) is determined by how early the diagnosis is made. Any adult with a “chalazion” that has failed two courses of treatment, recurs at the same site, or is associated with lash loss or diffuse lid thickening needs a biopsy, not a third I&C.
Clinical Pearls: Chalazion
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Always send the specimen. SGC has been missed in chalazion specimens that were discarded without histopathology.
Published case series document multiple instances where sebaceous gland carcinoma was found in routine chalazion specimens sent for histopathology, where the clinical appearance was entirely consistent with a benign chalazion. The cost of sending a specimen is minimal; the cost of missing SGC is significant. Make histopathological submission the default for all chalazion excisions, particularly in adults over 40, in unilateral recurrent disease, and in any case with lid margin abnormality.
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Triamcinolone injection via the posterior approach avoids skin depigmentation. This matters in darker skin tones.
Depigmentation after transcutaneous triamcinolone injection is an underappreciated complication, particularly visible and distressing in Fitzpatrick IV-VI skin types. The posterior (tarsoconjunctival) route deposits the steroid directly into the chalazion without traversing the dermis, significantly reducing this risk. In patients with dark skin where depigmentation would be cosmetically unacceptable, the posterior approach is preferred even when technically slightly more difficult. If the transcutaneous route is unavoidable (lower lid), use the lower concentration (10 mg/mL), inject as little as possible, and counsel about the depigmentation risk explicitly before proceeding.
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Treating the chalazion without treating the MGD guarantees recurrence.
A chalazion that forms in an eye with untreated posterior blepharitis is the visible manifestation of a lid margin that is producing obstructed meibomian glands continuously. Removing the current chalazion by I&C resolves the immediate problem; it does not change the underlying gland obstruction, bacterial lipase load, and inspissated meibum that will produce the next one. Every patient with a chalazion needs a lid hygiene and warm compress routine as maintenance, plus assessment for doxycycline if MGD is moderate to severe. The patients who keep coming back for repeat I&C every 6 months are the ones where this management step was omitted.
Further reading: RCOphth Oculoplastics Guidelines. For the underlying eyelid disease context see blepharitis and dry eye disease. Specialist context: oculoplastics and orbit subspecialty page.