Hailstone (chalazion)

A Chalazion, also as Hailstone known is a cyst in the eyelid. This is caused by inflammation of a blocked gland on the upper eyelid. A hailstone differs from a stye (hordeola) in that it is a subacute and usually painless nodule.

What is a hailstone?

The glands affected by a chalazion are the meibomian or eyelid glands located in the eyelid. There are around 30 to 40 of these sebum glands in each of the upper and lower eyelids. They produce a thick fluid that is contained in the tear film of the eye and lubricates the surface of the eye.

A hailstone is the result of a swollen sebum gland in the eyelid caused by chronic inflammation after a blockage of the gland duct. The cyst tends to become larger than a stye, but after swelling is painless and is considered harmless.

Adults are more likely to suffer from chalazion than children. Recurring chalacias in the same location can sometimes be a symptom of sebum cancer, a rare type of cancer.

causes

A chalazion is the result of an inflammatory process. The narrow opening through which a meibomian gland secretes its secretion can become clogged as a result of narrowing of the opening or hardening of the sebum fluid near the opening.

The back pressure thickens the walls of the gland and the secretion in the lid itself. This leads to inflammation both within the gland and on the eyelid and finally to the formation of a cyst (hailstone).

One possible cause of a chalazion is incomplete removal of eye makeup, which is what collects the oil from the cosmetic product in the glands.

Inflammation of the edge of the eyelid (blepharitis) as a result of the overproduction of sebum due to meibomitis or inflammatory skin diseases such as acne vulgaris or acne rosacea can also cause a hailstone.

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Symptoms, ailments & signs

A chalazion is a clearly recognizable lump on the eyelid.Outwardly it resembles stye, but in contrast to it, it is usually not painful. In contrast to this, the course is not acute either, but only develops gradually over several weeks and grows slowly. It is characteristic of the hailstone that it can be moved.

The chalazion is usually about the size of a hailstone, which is why it is also called that. In some cases, much smaller chalacia also appear. The simultaneous presence of several hailstones is unusual. Normally a chalazion does not cause any pain, but it can occur in connection with an uncomfortable feeling of pressure in the eye, which can arise from the friction.

This can sometimes cause irritation of the eyes and inflammation of the conjunctiva (conjunctivitis). The affected eye is clearly reddened. There may be increased sensitivity to light and increased tears. In rare cases, hailstones can be so large that they affect vision. Without treatment, the hailstone usually disappears completely within a few months or years.

Diagnosis & course

Symptoms for the development of a chalazion are swelling of the eyelid combined with sensitivity to pressure, light sensitivity or a perceived heaviness of the eyelid.

A bump appears clearly visible on the eyelid. A chalazion usually occurs in the upper eyelid. Smaller chalazions disappear over time, while larger chalazions become more permanent or even increase in size.

Enlarged hailstones can increase the pressure on the eyeball and cause blurred vision. There is also the risk that the blocked gland will become infected secondarily, which in turn leads to irritation, pain and inflammation. The eyes are checked with regard to visual function and field of vision for a relatively unambiguous diagnosis.

In order to reliably differentiate a hailstone from a stye, the attending physician will also fold down the affected eyelid to examine the inside. In addition, a palpation examination will check the mobility of the chalazion.

Complications

A hailstone is usually not much larger than a grain of rice and only needs to be treated with eye drops or ointment if the inflammation is severe. Very often it develops back on its own without complications, which does not require any further measures. However, in some cases it can swell. Then the hailstones endanger eyesight and surgery is necessary to remove the lump of tissue.

Otherwise, larger hailstones persist for a long time without swelling. Conjunctival complications can also occur. Surgery is only performed if the chalazion is very painful or larger than normal. Because here too rare complications are possible. While most of those affected no longer have symptoms a few days later, as with any operation, bleeding and infections cannot be ruled out.

Damage to the optic nerve or the eye itself during surgery is also possible. Sometimes a scar is also left behind, causing the eyelid to twist. Normally, no traces of the operation remain on the eye. Recurring inflammation can indicate underlying diseases such as diabetes mellitus or other metabolic diseases and must be examined for this.

When should you go to the doctor?

Normally, a hailstone does not require medical treatment. It is a harmless inflammation of the eye gland that heals on its own after a few days. If the symptoms have not subsided after a week at the latest, a visit to the family doctor or ophthalmologist is indicated.

Accompanying symptoms such as severe pain, pus formation or visual disturbances also require medical treatment in order to avoid the development of serious complications. If another hailstone forms after the treatment, a comprehensive examination is required in any case.

The symptoms may be caused by an allergy or a serious illness that needs to be diagnosed and treated. In individual cases, recurrent inflammation can develop into an eyelid tumor. Therefore, recurring complaints should be examined by a specialist.

High-risk patients such as people with chronic eye diseases, allergy sufferers, children, the elderly and pregnant women should have a hailstone clarified immediately by their family doctor. Other contact persons are the ophthalmologist, the naturopath and, in the case of severe complaints, the medical emergency service.

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Treatment & Therapy

Treatment will initially be carried out without surgery. To do this, a hot compress can be pressed onto the affected area or lightly massaged to get the glandular secretions flowing again. Homeopathic remedies are also excellent for treatment.

If antibiotic eye drops or eye ointments such as chloramphenicol or fusidic acid do not subside a hailstones, surgery is recommended. Chalazion removal is an outpatient treatment that usually takes no more than 15 minutes. Due to the risk of infection and severe damage to the eyelid, such procedures should only be performed by a doctor.

The eyelid is numbed with a local anesthetic. A clip is then placed on the eyelid to hold it in place and turn it over. The doctor will then make a 3 mm incision on the inside of the eyelid to scrape out the chalazion.

Since scarring of the eyelid can cause visual problems, surgery will only be considered as a last resort. Although chalacias are rarely dangerous, it is common to send pieces of tissue in for biopsy for cancer screening.

Outlook & forecast

The prognosis of a hailstone is favorable. The small or medium-sized hailstones usually regress completely within a few weeks. No consequential damage or impairment remains. Many patients suffer from the visual flaw caused by a hailstone. The emotional state of the person concerned usually improves as the foreign body subsides.

Large hailstones can temporarily impair vision. Since the eyelid cannot be moved as usual, the affected person's field of vision is severely restricted. Many doctors recommend surgery in these cases. If the patient decides to have the hailstones removed by surgery, they are then usually considered symptom-free. If there are no further complications or delays in the healing process, the patient is discharged from treatment after a few days as cured.

The eyelid can be opened as usual after the wound has healed. This completely re-establishes the ability to see, as the presence of a hailstone has no influence on the functionality of the eyeball or the processing of information from the incoming sensory stimuli. Only the field of vision is restricted by the foreign body.

If hailstones recur in the course of life, the prognosis is also favorable. The course of the disease and the treatment options remain unchanged if it comes back.

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prevention

Thorough eye hygiene is recommended to prevent hailstones. This includes thorough make-up removal and cleaning of the eyelashes as well as meticulous cleaning of required contact lenses. Basically, a strengthening of the immune system also helps to counteract inflammatory processes.

Aftercare

In most cases, there are no special or direct measures and options for follow-up care available to the person affected by a chalazion. However, these are also not necessary, since it is a harmless disease that usually disappears on its own without treatment having to be initiated. However, if the chalazion persists and does not go away on its own, an ophthalmologist should be consulted.

This can possibly prevent further complications and complaints, which in the worst case would lead to complete blindness of the person concerned. A chalazion can be treated relatively well with eye drops or an eye ointment. These drugs should be used regularly and in the correct dosage. A doctor should always be consulted if anything is unclear or if you have any questions.

If the chalazion does not go away by itself through the measures and means of self-help, a doctor should be consulted immediately. The affected eye should be spared and protected particularly well with the chalazion. Especially after an operation, the eyes are particularly well protected. Usually this disease does not reduce the life expectancy of the person affected. Furthermore, aftercare measures are no longer necessary.

You can do that yourself

A hailstone can be treated very well with just a few measures. It is advisable to put on a warm compress to loosen the accumulation of secretion. The heat expands the pores and causes the secretion to drain away. Disinfecting and anti-inflammatory plant extracts can also be added to the warm water: These include sage, rock rose and chamomile.

If the inflammation spreads to the rest of the eye, eye drops can also be used. Administration of antibiotics is usually not necessary. Eye drops are commercially available agents with hyaluronic acid - these ensure long-lasting moisturization - or based on the plant eyebright. Euphrasia - the Latin name - is offered in the form of ampoules or globules. In this way an internal and external application can take place. The intake of selenium - an anti-inflammatory micronutrient - is also a useful internal support.

If the hailstone does not heal and there is a risk of scarring, it is necessary to go to an ophthalmologist or surgeon. This would remove the chalazion in an outpatient procedure. However, due to the risk of infection, this is the last option of treatment.

As a preventive measure, eye make-up should always be removed thoroughly. Thorough hygiene also applies to contact lenses used. In order to care for the eyelid rims, those affected can fall back on completely natural means: olive or coconut oil have a disinfecting and caring effect at the same time.