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Styes, Hordeola and Chalazia – a Three-Part Series. Part Three: Procedural and Surgical Treatment*

May 14, 2019

If you have a chalazion that has not improved with warm compresses, there are two further treatment options available.  The first option is having your doctor inject your chalazion with steroid medicine.  The second option is having your doctor surgically drain the oily material filling your chalazion.  Before comparing the pros and cons of injection versus drainage, let’s review the process of drainage surgery. 

 

Drainage surgery is generally performed at a doctor’s office, although some doctors perform the surgery at day-surgery center.  The first step of the surgery is getting you comfortable:  your doctor will typically inject your eyelid with numbing medicine to treat pain during the surgery.  Once your eyelid is numb, most doctors will roll your eyelid with a small clamp to expose your eyelid’s inner surface.  Then your doctor will then make a small incision on the back of your lid, allowing your doctor to drain the oily material built up within the chalazion.  You can expect bruising and swelling after the procedure, although the degree differs between patients.  Now that you have a better idea of what is involved with drainage surgery, we’ll spend the remainder of the blog post comparing steroid injections to drainage surgery. 

 

Both options have merit, although there is significant controversy about which is better.  The controversy exists because there is not enough high-quality medical research to guide doctors.  Existing research typically involves either a small number of patients or is of poor quality, although there are exceptions.  One exception is a study published in 2016 by Aycinena and colleagues.  Aycinena and colleagues found having your doctor surgically drain a chalazion is more effective than simply injecting steroid medicine into it:  approximately four in five patients improved with drainage whereas about three in five patients improved with one injection.  While one drainage is more successful than one injection, multiple injections spaced over several visits does improve the success rate of injections.  Clearly both injection and drainage succeed some of the time, but Aycinena and colleagues showed neither succeed all of the time. 

 

While success is a key factor in picking a procedure, so are convenience and comfort.  Doctors advocating steroid injections usually highlight the improved comfort of injections over surgical drainage.  Indeed, Aycinena and colleagues reported patients find injections both more comfortable and convenient than surgical drainage, although patient satisfaction between the two is similar.  While Aycinena found injection is typically more comfortable than drainage, comfort can depend substantially on your doctor’s technique. 

 

Beyond comfort and success, safety and side effects are other important factors to consider.  One side effect of steroid injections is cosmetic:  in a small number of patients, the medicine is visible through the skin as a white deposit.  Typically, this resolves slowly on its own, but it may rarely require surgical removal.  Steroid injections can also lighten the skin, a process known as depigmentation.  These side effects are mainly cosmetic, but rare vision-threatening side effects can occur with either steroid injection or drainage.  Talk with your doctor about risks before you proceed with either option.   

 

In summary, I hope you see there is a role for both steroid injections and drainage surgery, depending on how you and your doctor decide to balance success, comfort, convenience and risk.  The decision is a personal one, and there is no right answer. 

 

References: 

 

Aycinena AR, Achiron A, Paul M, Burgansky-Eliash Z.  Incision and Curettage Versus Steroid Injection for the Treatment of Chalazia: A Meta-Analysis.  Ophthalmic Plast Reconstr Surg. 2016 May-Jun;32(3):220-4. doi: 10.1097/IOP.0000000000000483. Review

 

*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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