The following information provides a guide for GPs on how to manage and make a referral for presentation of Chalazion in children.
Do not refer (See GP management & self care below)
GP management & refer to eye clinic (non-urgent)
Recurrent chalazia with red / painful / photophobic eye
Urgent referral to Eye Clinic; if acutely red swollen lid see “preseptal cellulitis” pathway
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
Always include:
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
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
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.
English
All From Moorfields Eye Hospital NHS Foundation Trust
Last updated: April 2021