Chalazion explained: the painless eyelid lump and how to treat it

A chalazion is a firm, painless lump inside the eyelid caused by a blocked meibomian (oil) gland. Meibomian glands sit in a single row along the upper and lower eyelids and produce the oily layer of the tear film that stops the tears evaporating. When one of these glands becomes blocked, oil accumulates behind the blockage and gradually forms a smooth, rubbery cyst. Chalazia are very common, affect all ages, and are not caused by poor hygiene.

Unlike a stye — which is a hot, red, painful infection at the base of an eyelash — a chalazion typically feels firm rather than tender, sits in the body of the eyelid rather than at the lid margin, and develops over days to weeks rather than hours. Many chalazia start as a small tender swelling that settles into a painless lump.

Who gets chalazia?

Anyone can develop a chalazion, but they are more common in people with blepharitis, rosacea, meibomian gland dysfunction or dry eye. Recurrent chalazia — three or more in the same eyelid — are almost always a marker of underlying eyelid margin disease that needs to be treated as well as the individual lump.

First-line treatment: warm compresses and lid hygiene

The vast majority of chalazia settle without any medical treatment, provided they are treated early with warm compresses and gentle eyelid massage. The technique is simple: apply a clean flannel soaked in comfortably hot (not scalding) water to the closed eyelid for 10 minutes, then gently massage the lump towards the eyelid margin with a clean fingertip. Repeat 3–4 times a day for 2–3 weeks. Rechargeable heat masks (such as EyeBag or Bruder) are equally effective and easier to use consistently.

Warm compresses melt the trapped oil, and the massage encourages it to drain. Around half of chalazia settle within a month with this approach alone.

Steroid injection

If a chalazion has not settled after 4–6 weeks of warm compresses, or if it is very large, a small triamcinolone (steroid) injection into the lump can be very effective. The injection is given in clinic under local anaesthetic drops through the inside of the eyelid, so there is no visible needle mark, and around 80% of chalazia resolve within 2–3 weeks. A second injection is sometimes needed. Steroid injection is particularly useful for chalazia at the outer or inner corner of the eyelid, where surgery is less straightforward.

Incision and curettage

For persistent or very large chalazia, a small incision and curettage is a definitive treatment. The lump is opened from the inside of the eyelid under local anaesthetic — so there is no visible external scar — and the contents are gently scooped out. The procedure takes 10–15 minutes, the eyelid is padded for a few hours, and most patients return to work the next day. The recurrence rate at the same site is low.

Preventing recurrence

Recurrent chalazia are almost always a symptom of untreated blepharitis or meibomian gland dysfunction. Long-term prevention rests on a daily lid-hygiene routine (warm compress, eyelid massage and lid margin cleaning), management of any underlying rosacea, and treatment of dry eye. In selected patients, in-clinic treatments such as LipiFlow, Blephex or intense pulsed light (IPL) can dramatically reduce the frequency of new chalazia.

When a lump is not just a chalazion

A persistent or recurrent lump in the same spot in an older adult must be biopsied to rule out a rare but important eyelid cancer called sebaceous gland carcinoma. Any chalazion that does not settle after appropriate treatment, that keeps returning at the same site, or that is associated with loss of eyelashes should be assessed by an oculoplastic specialist.

Related reading: see our consultant ophthalmologist services, full eye service list, and related guides on ptosis (drooping eyelid) and xanthelasma. Interested in vision correction? Read about laser eye surgery and lens replacement surgery.

If you have a lump in your eyelid that has not settled after 4–6 weeks of warm compresses, book a free 15-minute call or request a consultation — most chalazia can be treated quickly and effectively in a single clinic visit.