Chalazion Cysts

Blech!

They're icky. You're forewarned. If you don't have any problems with the health of your eyelids, and you are squeamish, I recommend that you stop reading right now. Because chalazion cysts are ICKY.

And I get them. Lucky me. If you're still reading, you may be one of my lucky brethren. Congratulations. Bleh.

Now for the quicky disclaimer. I'm not a doctor, nor do I play one on tv. I'm just an unfortunate laywoman who gets a lot of chalazion cysts, who has learned a lot of hard-won lessons about them, and who would l.ike to share some of that knowledge with you in case it might save you some trouble. If I've got something wrong here, I apologize, but I'm not claiming to be a medical expert. We're talking folk medicine, here, folks.

Besides Icky, What Is A Chalazion?

As I understand it, a chalazion cyst is sort of like a pimple on your eyelid. Just as your hair needs oil secreted from glands to keep it shiny and supple, your eyelashes need the same sort of care. So your eyelids have glands in them, and tiny pores at the bases of your eyelashes, where the oil gets secreted to keep your eyelashes luscious and flirtatious.

Unfortunately, some people's eyelid glands aren't so good at their job. They get plugged up periodically, just like when one of the pores on your face gets clogged and forms a pimple. When this happens on your eyelid, it forms a chalazion cyst, which isn't luscious or flirtatious at all. In fact, it's pretty darn unattractive.

What this looks and feels like is just a bump on your eyelid, and it can occur pretty much anywhere on the upper or lower lid. It doesn't really look like a pimple, because it doesn't usually form a head (more about this later) ... so it's just a regular skin-colored bump, like there's something under the skin there. Which there is. A ball of pus-type stuff. Ewwww. I warned you this was icky, didn't I?

Some people are just prone to chalazion cysts. Lucky us. We get them every once in a while, if we don't keep up with the preventative care (more about this below). If you've never had one before, and you think you've got one now, go talk to your doctor and don't try to just take care of it yourself. If you've had a gazillion chalazions before (and you know who you are), then this webpage might give you some helpful hints about self-care.

Right up front, I'm going to tell you something your doctor probably won't. At least, none of my doctors did ... I had to learn it from a book. What looks like a chalazion can actually be a sign of something much worse. If you frequently get chalazion cysts in the same location, it can be a sign of a sort of cancer. So if you get a lot of chalazions, watch where they're occuring. If they're all over the place, you're probably safe. But if they're always in the same spot, go have a serious talk with your doctor.

Stages of Chalazion Development

There are -- in my experience -- four common stages of chalazion cyst development:

1. Slight, subtle warning twinges: You won't detect this stage until you've had a few chalazions, but in fact there is a stage of warning signs. They're hard to describe, but you might feel slight soreness or twinges (for me, I usually notice this just when I'm waking up), or you might have a bit more-than-usual discharge from your eyes when you wake up. Otherwise, everything seems normal.
2. Swollen, red eyelid: At this stage, you might wonder if you're getting "pink eye" or something. Your eyelid is all puffy and bright red and tender to the touch, and you're probably getting a lot of icky eye discharge, especially at night. People keep asking you, "What's up with your eye???"
3. Bump on eyelid: The swelling, tenderness, and redness pretty much go away, and you're left with a bump which seems the size of an orange and you're certain that no one can possibly look at you without flinching in disgust, but most people stop asking about it, because -- actually -- it has become less noticeable.
4. Normal eyelid: Miraculously, while you aren't looking, the chalazion goes away. Honestly. They just go away on their own, like zits do. It might take more than a year, but it will just sneak away in the night. Scout's honor.

Prevention Is the Best Medicine

There are a few very useful things you can do to prevent chalazion cysts:

• Warm compress: I find this to be a) the most often medically recommended and b) most reliable method of prevention. If you do a good warm compress every day for 10 or 15 minutes, you probably won't get a chalazion ever again. If you can't manage daily compresses, then at least watch out for those warning twinges, and the moment you think you might be starting to get a chalazion -- before the swelling even starts -- do a couple of compresses in the same day. If the swelling has already started, make the compresses longer, and do them as often as you can. Sometimes, you can head off a chalazion in these early stages with frequent warm compresses. (More details on warm compresses below, with lots of how-to info.)
• Johnson's Baby Shampoo: This might sound ridiculously simple, but just washing your eyes a couple times every day with no-tears soap can do wonders. Kinda like washing your face to avoid zits ... it gets rid of the surface bacteria. And, really, how hard would it be to add this to your daily washing habits? It takes about a minute.
• Antibiotic ointment: If you've got really persistent chalazions -- or you have an important event coming up, like your wedding -- you might consider asking your doctor to prescribe short-term use of an antibiotic ointment. You just squeeze a little bit of this slimy stuff into each eye before bed each night, and it seems (in my experience) to completely prevent chalazions from occurring. The drawbacks, however, are worth seriously thinking about. First, there's the ick-factor. These ointments cling very persistently to your eyelashes, even after repeated washings with no-tear soap (see above), and if you wear glasses this can be really disgusting, leaving stripes of slimy ointment on your glasses all day long every day. And the ointment doesn't like to come off the glasses, either. But the larger drawback, much worse than surface ickiness, is simply that using antibiotics on a regular basis seems like a really really bad idea, for reasons that have become obvious to pretty much everyone by now. So I try to be careful about using antibiotic ointments for my chalazions, and only use them when one explodes (blagh! More about this below), in the two weeks before my wedding to guarantee lack of chalazions in wedding pictures, or by my doctor's advice to break a particularly persistent cycle of chalazions.

Warm Compresses

The basic idea of the compress is to treat the eyelid with three things simultaneously: heat, moisture, and pressure. Here's a bit of info about each of those:

• Heat: Don't scald yourself. At the same time, a lukewarm compress is just a waste of your time. Make the compress as hot as possible without injuring your skin. One of my eye doctors said, "Make it as hot as you can stand it," but I find that isn't good advice, because I can stand more than my skin can, and I've ended up with blisters from over-enthusiastic compressing. So use your best judgment, and try not to hurt yourself.
• Moisture: The point here is to have a moist heat, rather than dry heat. That doesn't mean water should be dripping down your arms and face while you compress. Whatever you are using to provide the moisture, make sure you've wrung it out really well, so that it's damp, but not wet. Don't let it get too dry, if you're doing a compress over a long period of time, either. In short, keep it damp but not dripping.
• Pressure: Don't press hard, just very very gently. If you press too hard, you'll end up with eye pain, not to mention the fact that you'll be seeing spots for hours afterward. (You may find that even with the most gentle pressure, your vision will be impaired for a time after the compress. Even gentle pressure can subtly and temporarily change the shape of the eyeball, and it just takes a little while for it to bounce back to normal.)

There are a few ways to actually make and apply a compress. Here are a few of the methods I have tried, and my analyses of their efficacy and convenience:

1. Washcloth and hot running tap water: Wet a washcloth thoroughly with hot tap water, as hot as possible without scalding yourself. Then fold the washcloth into thirds (or whatever works for you) and place it over your eyes. The problem with this method is that the washcloth gets cold quickly, and you need to repeatedly take it back to the sink and run hot tap water over it again, then wring it out again, then reapply it. This method usually left me sitting on a chair or toilet seat right next to the sink, so that I would not interrupt the compress for too long. Not very comfortable.
2. Washcloth and bowl of hot water: This is very similar to option #1, except that you fill a large bowl with very hot tap water and bring it with you while you apply the compress. That way, you don't have to run back to the sink. However, the water in the bowl can also cool quickly, leaving you with the same problem as above.
3. Dishcloth and hot/cold pack: After years of experimentation, this is my method of choice. I wet a dishcloth (you may call this a "tea towel," depending on your country of origin) while heating a hot/cold pack (these are usually rectangular flexible plastic thingies, sold for wrapping around injured ankles and such) in the microwave. Be careful not to microwave it too long (on my microwave, 1 minute 10 seconds is perfect, but your mileage may vary), and keep testing it to see if it's too hot to touch. When the hot pack is the right temperature, wrap it in the towel and you have a compress good to last about 20-30 minutes without reheating. Very convenient.

Some basic compress hints:

• Doctors tend to be a bit vague about how long you should spend with each compress. One of mine told me "As long as you can stand it" (I think he was also the one who told me to make it as hot as I could stand ... ah, precision in medicine!). I generally try for 15-30 minutes.
• The frequency with which I perform compresses depends upon the state of my growing chalazion. In the earliest stages, I will apply compresses as often as possible in one day (often only allowing an hour or so between applications), in hopes of averting the impending cyst. This often seems to work for me, and the swelling subsides and the cyst never actually develops.
• One of my doctors recommended massaging the eyelids after each compress, in an effort to encourage the material inside the chalazion to break-up into the bloodstream and go away. Therefore, I very gently massage the eyelids for about 30-60 seconds with the corner of my moist washcloth or dishtowel after each compress. I usually follow this up with a quick washing of both eyes with no-tear soap (such as Johnson's Baby Shampoo). I sometimes combine the massage with the washing.
• I find that it's most comfortable to apply a compress while lying down. That way, you can just rest the compress on your eyes, then rest your hand lightly upon the moist towel without really having to press.
• If you have a significant other or housemate, see if they are willing to read to you while you do your compress. Otherwise, you might want to put on some especially enjoyable music. It makes the time pass much more quickly.
• You can, of course, apply a compress to only one eye at a time, but I generally advise just doing both at once. After all, compresses also help with prevention, and you're going to be lying there bored for 15-30 minutes anyway, so why waste the opportunity?
• If you have a chalazion on only one eye and are applying the compress to both eyes, be careful not to reuse the same towel for future compresses. According to one of my doctors, you can accidentally infect the healthy eye by doing this.

Ack! I Have One! Now What Do I Do?

Okay, so the preventative care is no longer an option, and the swelling has gone down, and you've got yourself a pretty solid bump there on your eyelid. What do you do now? Well, again, you've got a number of options. Regardless of what your doctor says, you do have options. Here are the ones with which I'm most familiar:

• Let it be: As I said above, chalazion cysts will go away of their own accord if you just allow them enough time. However, if you have a chalazion that's big enough that it's putting slight pressure on your eyeball and blurring your vision in that eye (this happens to me every time I get a really large chalazion), it might not be worth waiting it out. But if the chalazion isn't impairing your vision and your vanity will allow it, simply waiting will eventually achieve the desired result, and the dread bump will vanish.
• Hopeful compresses: I've had some doctors tell me that -- once the swelling has gone down and you've just got a bump -- compresses won't accomplish anything anymore and you're just wasting your time. I've had other doctors tell me the exact opposite: that compresses can soften and loosen the contents of even an old and established chalazion cyst until it goes away. Well, it certainly can't hurt anything to try.
• Steroid injection: Okay, this is not fun, but it's better than the following choice, which is surgery. A doctor can inject a very small amount of steroid directly into the chalazion cyst (the worst part of this is the anesthetic needle, described below under "Surgery"), which causes the cyst to simply shrink and go away. Poof! Like magic! It's fast, it seems to have no side effects, and the chalazion is gone within a few days, in my experience.
• Surgery: Some doctors will insist that you need to have surgery to remove the chalazion. Don't believe them, as I've said above. There are better options. But if you do have surgery, the process involves a very large needle (of anesthetic) getting stuck into your eyelid -- which hurts like hell -- then some cruel stranger turning your eyelid inside out so that you can't avoid watching while he scrapes all the pus out, leaving you with a bloody eyelid that is even uglier and puffier than before, underneath a big gauze bandage. In my experience, the scarring from surgery took so long to subside that surgery was a worse deal than just waiting for the chalazion to go away on its own.
• Exploded eyelid: This is an uncommon choice, and probably the least pretty. This only happens if you impatiently do really hot compresses really regularly for a few days straight. The chalazion will basically pop like a zit, after forming a white head. Not recommended for the weak-of-heart, because it is ultra-icky, and results in a pus explosion, followed by a long-lasting oozy scab, followed by scarring ... none of which I recommend as fun stuff. I must admit that the chalazion does go away faster this way, but please notice that this is only one of many options, and I don't think it's worth it. If you follow the above advice on how to do compresses in moderation (not too hot, not too much pressure, not too long), they should not lead to such trauma as I've described here.

  Note: If you do end up with an exploded eyelid, here's my advice:

  1. Apply another hot compress as soon as possible, to try to draw out as much of the pus as possible. Ideally, you will eventually see only blood on your cloth, and no white discharge from the sore.
  2. Rinse the eyelid gently with cold water to try to slow the bleeding, then very gently pat it dry.
  3. Immediately ask your doctor for some antibiotic ointment and apply it as directed. Otherwise, the stuff oozing out of the open sore can lead to other infections.
  4. Try not to touch the resulting scab. Just give it time to heal, even if you're tempted to pick at it. You'll just make the scarring worse, if you do.

Not Sure If You Have A Chalazion?

Got a weird bump on your eye, but not sure if it's a stye or a chalazion or something else entirely? Then you should go see a doctor as soon as possible. Please don't email me asking me to help you diagnose what's going on with your eye (a lot of people have done this), because (1) I'm not a doctor, and (2) I can't see your eye over the Internet, anyway. You need someone with expert medical knowledge to actually look at your eye and talk to you. I'm happy to receive emails about the content of this page, but I can't help you with diagnosis.

Go see a doctor!