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

• 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

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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