Old Chalazion Scar or nodule

[Worriedmom777777]

My four year old daughter has had multiple chalazia since she was 2.5 years old.  All of the bumps start as a hard lump under the skin and then within a month, the bumps poke through the skin (erupts) and heals until the bump shrinks down to a very tiny nodule on the skin with some redness. The oldest chalazia is about 16 months old and has been in the current state for about a year. There appears to be some scarring where the skin is tight and darkened. The old nodules do not get worse or better, but the small lump is very unsightly. I have seen a numerous pediatric opthalmologists and occuloplastic surgeons and they have different opinions as to the treatment for the scar.  Interestingly the occuloplastic surgeons recommend that I leave them alone for fear of further scarring from surgery and depigmentation and skin atrophy from steroid shots, Some opthalmologists recommend surgery and steroid shots.  I am very confused as to what I should do.  I am so very frustrated and worried that my daughter's eyelids will be disfigured if I don't do anything and yet I am not sure if surgery is the right thing to do. Will the skin eventually flatten out and heal or will it remain as a scar tissue.

[John C Hagan III, MD, FACS, FAAO]

Doubtful anyone will do any surgery or biopsy until you have stopped breastfeeding or unless your pediatrician gives OK and it truly looks like an emergency (which yours does not seem to be).

Use the search feature and archives and read about the treatment of blepharitis and chalazia.

If you live in USA go to www.geteyesmart.org and find an oculoplastic Eye MD ophthalmologist that you can get to reasonably.

I doubt a dermatologist will be helpful

JCH MD

[MRR_2013]

I have several chalazia in both my eyes; I've counted 8. Two of which are large, red, and inflamed. My ophthalmologist claims there is nothing he can do for me because I am breastfeeding and I can't take tetracycline. I asked about the excision surgery and he said, "it's not surgical". I'm not really sure what that's supposed to mean, especially since I've read that it's quite a simple procedure. My other concern is sebaceous carcinoma, since I have had these for quite some time. My ophthalmologist laughed at me when I asked and said, "it's not cancer!" I was quite offended by this since I don't think it's wrong for me to inquire, and it's not a lot of work to biopsy it. I left his office in tears with NO treatment. What is your opinion on this? I asked my GP to send me to another ophthalmologist and he decided to send me to a dermatologist (since I will be able to get in a lot faster), I'm not sure if they'll be able to help but I sure hope so.

[John C Hagan III, MD, FACS, FAAO]

The American Academy of Ophthalmology is pleased to provide this free information "to the world".

JCH MD

[Worriedmom777777]

Thank you very much.  You have been most informative,  helpful and probably spent more time disussing the issue with me than most of the ophalmolgists and oculoplastic surgeons I've seen so far (and I have seen quite a few).  I really do appreciate it.  I will keep you posted so that others may learn from our experience.  It appears that my daughter has a rare case of really long lasting (albeit tiny) chalazia.

[John C Hagan III, MD, FACS, FAAO]

It is rare for a chalazion that is regressing and fibrosing to have anything left after a year or two that needs to be excised. I see a chalazion every week or two but no surgical excisions of cosmetically disturbing nodules that are over a year old in the last 10-12 years.

JCH MD

[Worriedmom777777]

but will this mass of fibrotic tissue ever go away completely after many years or could it be permanent.  Hqve you seen cases where it did not after many years?

[John C Hagan III, MD, FACS, FAAO]

The chalazion is like a whitehead on the skin. It produces an oil that is needed by the tear film to keep the tears from spilling out over the eyelid and running down the cheek.

When the oil cannot drain (big gland, little bitty opening which is easy to block off espcially if oil production is high) it accumulates and a hard, non-tender mass forms. The oil turns rancid and causes an inflammatory mass that may erode through the wall of the gland onto the skin or into the back of the eyelid (tarsal conjunctiva). Whether the chalazion resolves by itself or requires steroid injection or surgical incision and currettement it forms fibrotic tissue which essentially is like scar. It may be so small it cannot be seen or felt (the ideal result) or a mass of fibrotic tissue that can be seen and/or felt for months to years.

JCH MD

[Worriedmom777777]

thanks and sorry about double posting.

I have been doing hot eyecompress and Occusoft foam cleaser  2-3 times per day.  I have also recently eliminated dairy from her diet.  Hopefully, she won't get any more new ones.

I thought chalazia do not form scars but I guess it happens somtimes?

I agree with you on that we can always choose to do surgery later...

[John C Hagan III, MD, FACS, FAAO]

There is no way I can tell you what to do but the most conservative, least expensive and lowest risk is to follow the oculoplastic surgeon's recommendations.

If cosmetic surgery is needed it will be easier when she's older and the eyelids bigger.

Also use the search feature and archives and read about the treatment of blepharitis the most common cause of chalazion to reduce risk of more forming.

Suggest you visit the websites of Occusoft and TheraTears SteriLid and read about their lid cleaning products.

JCH MD