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Styes, Hordeola and Chalazia – a Three-Part Series. Part Two: Conservative treatment*

Right upper eyelid chalazion

Today we’ll focus on treating chalazia conservatively, without surgery or procedures. For years, we did not have good evidence to guide us when treating long-standing oil gland cysts, also known as chalazia. (For an overview of chalazia, see our last post). In 2018, a team of American and Canadian eye surgeons (ophthalmologists)(Wu) tackled the problem of low-quality medical research guiding the conservative treatment of chalazia. The team wanted to know if using warm compresses at home could help patients avoid a surgery or procedure. They also wanted to know if using medicines, like antibiotics or steroids, offered any additional benefit. The American-Canadian team found approximately one in five patients improved at four-to-six weeks with warm compresses. They also found adding antibiotics or steroids did not improve the success rate.

Given the success rate of conservative treatment is only one in five, I think it would be reasonable if you asked yourself “Are warm compresses worth the hassle?” My own opinion is warm compresses are probably worth it, assuming your doctor indeed diagnoses you with a chalazion.* I base this on an important caveat found by the American-Canadian researchers – a caveat suggesting the success rate of warm compresses may be close to 50%. The caveat is many study patients did not complete the study, as approximately one in three patients did not return for their final follow-up visit. The researchers argue many of these patients may have actually improved at home and simply did not return for their follow-up visit. I think this is a reasonable assessment, because if your chalazion improved, would you make a trip back to the doctor to tell your doctor your chalazion was gone? Some patients would, but many do not. If the patients that did not return got better, then warm compresses may work half of the time. If warm compresses work half of the time, then I think they are worth trying. At the very least, discuss this with your doctor to come up with a logical treatment plan for you.

Since warm compresses may work up to half of the time, I’ve summarized the technique for warm compresses used in the study. Study patients were instructed to take a clean washcloth and run it under hot tap water and place the warm compress on the closed eyelids for ten minutes, twice a day. At the end of ten minutes, they recommended patients gently massage their chalazion. A word of caution, always check that the wash cloth is warm – and not hot – to avoid burning your eyelids.* Now that we have discussed a strategy for conservative treatment, with our next post we will turn our attention to treating chalazia that do not improve with warm compresses.

Wu AY, Gervasio KA, Gergoudis KN, Wei C, Oestreicher JH, Harvey JT. Conservative therapy for chalazia: is it really effective? Acta Ophthalmol. 2018 Jun;96(4):e503-e509. doi: 10.1111/aos.13675. Epub 2018 Jan 16.

*As always, any information on this website is informational and does not replace the need to see an eye care professional

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