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Chalazion

The following information provides a guide for GPs on how to manage and make a referral for presentation of Chalazion in children.

  • Early, Mild, Moderate

    • Chalazion present less than 6 months.
    • Small to medium size no pain or recurrent infection.
    • No visual impact.

     

    Do not refer (See GP management & self care below)

     

  • Chronic or recurrent

    • Chalazion present for 6 months or longer, family have used conservative management and are keen for surgery
    • Multiple recurrent chalazia
    • Recurrent preseptal cellulitis/infections
    • Large and/or uncomfortable cyst
    • Significantly distorting eyelid
    • Affecting vision

     

    GP management & refer to eye clinic (non-urgent)

  • Potential serious pathology

    Recurrent chalazia with red / painful / photophobic eye

     

    Urgent referral to Eye Clinic; if acutely red swollen lid see “preseptal cellulitis” pathway

GP management

Chloramphenicol 1% eye ointment 3 times daily into eye for 2 weeks if red and inflamed cyst.

If lid very red/ inflamed/swollen:follow “preseptal cellulitis” pathway

If recurrent: consider oral antibiotics.

Child under the age of 12 years: three-month course of oral erythromycin:

Age under 2 years: 125mg twice daily

Age 2 to under 12 years: 250mg twice daily

Age 12 and over: three-month course of oral doxycycline 100mg once daily

 

Referral information

  • Duration, size, pain
  • Affecting vision
  • Warm compresses used already?
  • History of recurrent chalazia
  • If possible, attach photo of eyelid to e-referral

Always include:

  • Child’s date of birth
  • Address
  • Child’s social worker details (including Borough), if any
  • Parent/carer contact phone number and email

 

Information for families

Self-care & advice

Benign lesion usually resolves with time over weeks-months

Twice daily warm lid compresses 1-2 weeks
if recurrent: warm compresses + lid massage and lid margin cleaning for prevention

Surgery is not usually recommended as benign self limiting lesion, 1 in 5 chance recurrent after operation, risks of operation and GA

 

Further advice

This pathway has been produced by Moorfields Eye Hospital NHS Foundation Trust to help clinicians manage the healthcare of children and young people. However, if you need to contact a Paediatric clinician, please see below for contact details:

Moorfields Eye Hospital:

Paediatric helpline: 0207 2533411 extn 4569, Mon- Fri 10:00am-13:00pm then 14:00pm-16:00pm 

 

video transcript
To clean the eyelids the first step is to do a warm compress which softens the debris on the eyelids making it easy to clean off.
Place a clean face cloth under a hot tap, nice and hot but not hot enough to burn or be uncomfortable. Wring it out and hold the hot compress on top of the closed eyes for one or two minutes.
If the cloth becomes cool, warm under the tap again, wring and replace it on the closed lids.
Next we perform the cleaning for older children we use a moistened cotton pad. This can be moistened in warm tap water or by using a weak solution of baby shampoo or bicarbonate of soda.
Squeeze out any excess moisture.
First you clean the back edge of the eyelid. Pull down the lower lid and run the bud firmly but gently along the thin line of skin behind the lashes four or five times.
 Do the same for the top lid putting it up and away from the eye. Then we clean the lashes. For the top lid, close the eyes firmly and scrub vigorously at the base of the lashes doing a small part of the lid at a time and moving gradually along the width of the lid to do all the lashes.
In the same movement to use for brushing your teeth. Then open the eye, look up and repeat with the bottom lid lashes, again moving gradually along the lid to ensure all the lashes are clean.
Ideally older children should be taught to do this themselves.
For younger children we start again with a warm compress.  Then use a face cloth to clean the lid edges moistened in warm tap water or with a weak solution of baby shampoo or bicarbonate of soda.
After moistening wring out the cloth wrapped the cloth tightly around the index finger so it covers the length of the finger holding the rest of the cloth in the hand.
With the child's eyes gently closed lay the finger with the length of the cloth along the lashes apply gentle pressure towards the eye and wipe up in a sweeping motion two to three times to clean the upper lid.
The gentle pressure towards the eyes will allow the eyelids to turn out a little so that the back edge of the eyelids are cleaned. Then wipe down two or three times in the same way to clean the lower lid.
To clean the base of the lashes; with your child's eyes tightly closed use the length of the the finger covered by the cloth to rub quite vigorously along where the lashes come out at the skin moving along the eyelids so that all areas are cleaned.

Last updated: April 2021