Meibomian cyst (chalazion) – quick guide for GPs

Learn how to identify, manage and treat a meibomian cyst – potential complications and differential diagnoses are also covered.
Meibomian cyst (chalazion) – quick guide for GPs
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This quick guide* covers the key points for GPs on meibomian cysts, and answers the following questions:

  1. What is a meibomian cyst and what causes it?
  2. What are the symptoms, signs and differential diagnoses?
  3. How should a meibomian cyst be managed and treated?
  4. What are the potential complications?

*This quick guide is deliberately concise and readers are strongly recommended to refer to the references listed at the end of the quick guide.



1. What is a meibomian cyst and what causes it?1–6

  • Diagram of eye showing the meibomian gland, lacrimal gland, and conjunctival goblet cell.Meibomian sebaceous glands are present under the inner surface of the upper and lower eyelids (see diagram) – there are 25–30 glands present on each eyelid
  • These small glands produce meibum, an oily fluid that lubricates the eye
  • If these glands become blocked, the oily fluid can collate and over time cause a sterile, inflammatory granuloma called a meibomian cyst – also known as a chalazion
  • Meibomian cysts occur in all age groups but are more common in adults
  • Risk factors include:
    • Blepharitis
    • Seborrhoeic dermatitis
    • Rosacea
    • Diabetes mellitus
    • Elevated cholesterol

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2. What are the symptoms, signs and differential diagnoses?1–4

Meibomian cyst (chalazion) on the upper eyelid of a woman

Symptoms:

  • A painless lump on an eyelid (mostly single lumps but can be multiple)
  • Occasionally blurred vision occurs from induced astigmatism

Signs:

  • Well defined, 2–8 mm diameter subcutaneous nodule in the tarsal plate
  • External conjunctival granuloma can sometimes be seen with lid eversion
  • May be associated with blepharitis

Differential diagnoses:

  • Stye – meibomian cysts tend to be larger and less painful, and present less acutely than a stye
  • Sebaceous cyst of the skin
  • Meibomian gland carcinoma (rare; to be considered if lesion is recurrent)

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3. How should a meibomian cyst be managed and treated?1,2,4,7

  • Up to one half of meibomian cysts clear up without treatment
    • If the meibomian cyst is not causing any problems, it is best to carry out watchful waiting
    • Reassure the patient but advise them that it can take weeks or months for a meibomian cyst to clear up
  • Hot compresses can be used to ease discomfort and help soften the contents of the cyst, so it drains more easily – advise the patient to:
    • Soak a clean face cloth in comfortably warm/hot water
    • Hold it firmly against the closed eye for 5–10 minutes, 3–4 times per day
    • Clean the eyelids twice per day using a cotton bud soaked in a weak solution of baby shampoo to help prevent further cysts forming
  • Antibiotic ointments are not recommended as the contents of the meibomian cyst are infection-free
  • Refer to an ophthalmologist if a meibomian cyst does not resolve with conservative treatment, is affecting vision or causing discomfort (based on clinical judgement):
    • An ophthalmologist may consider more invasive therapy, such as incision and curettage or intra-lesion steroid injections, particularly for meibomian cysts that have been present for >2 months

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4.  What are the potential complications?4,8,9

  • Large meibomian cysts can cause astigmatism and visual disturbances
  • Rarely, a meibomian cyst can become secondarily infected; if this spreads to other ocular glands or neighbouring tissues, this can cause periorbital or orbital cellulitis:
    • Periorbital cellulitis (also known as preseptal cellulitis) is caused by an infection anterior to the orbital septum
      • It does not cause visual impairment, limited/painful eye movement or protusion of the eyeball
      • There may be fever and malaise
    • Orbital cellulitis is an infection involving the deep soft tissue surrounding the eyeball, located posterior to the orbital septum – this is a medical emergency and requires urgent hospital admission
      • It is usually unilateral and has an acute onset
      • It is often associated with severe pain, limited eye movements, protusion of the eyeball
      • It is often accompanied by fever and malaise
    • Emergency referral to secondary care is required for:
      • Any patient with orbital cellulitis
      • All child with suspected periorbital cellulitis, as they should be considered to have orbital cellulitis until proven otherwise
      • All patients with either condition if they are systemically unwell
      • Those patients where there is doubt over the diagnosis
      • Where a patient with periorbital cellulitis is not responding to treatment

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References

  1. Clinical management guidelines: Chalazion (Meibomian cyst). The College of Optometrists [Accessed 23 May 2022]
  2. Chalazion. American Optometric Association. [Accessed 23 May 2022]
  3. Meibomian cyst (chalazion) – What is it? NICE CKS [Accessed 23 May 2022]
  4. Chalazion. Patient.info [Accessed 23 May 2022]
  5. Meibomian cyst (chalazion) – What are the risk factors? NICE CKS [Accessed 23 May 2022]
  6. Blepharitis. Patient.info [Accessed 23 May 2022]
  7. Meibomian cyst (chalazion) – Scenario: Management of meibomian cyst. NICE CKS [Accessed 23 May 2022]
  8. Meibomian cyst (chalazion): what are the complications? NICE CKS [Accessed 23 May 2022]
  9. Orbital and preseptal cellulitis. Patient.info [Accessed 23 May 2022]

Patient information

  1. Chalazion. Patient.info [Accessed 23 May 2022]

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