Chalazion in Toddler

[jessia]

My two year old has a pea sized chalazion on her lower right lid for 2 months.  We saw a  pediatric opthamologist who gave us the option of surgery or doing nothing.  I am wondering what the risks are to not having it removed?  It is really not a bother to her and cosmetically it is only noticeable when looking at her from the side.  We were not at all consistent about compresses initially, but have been doing them at least twice daily now.  Is it too late for us to try this therapy?  Should we try steriods prior to a surgical intervention? Thank you

[John C Hagan III, MD, FACS]

Most chalazia get better with time and if the ped ophthalmologist was comfortable with just observation then I would think you would be also.

Warm compresses are difficult in adults and children (compliance problems) and even more so in infants. If you can and are willing to try this again then by all means do so.

It certainly would be worth it to try a round of antibiotic drops. Ask your Eye MD about Iquix.  It would be the Eye MD's option also to try a short (2 weeks or < ) of a antibiotic/steroid drop like tobradex.

Also discuss using TheraTears SteriLid lid to clean the lid of the oil that plugs the pores and causes this problem.

JCH III MD

[jessia]

Thank you for your prompt and helpful response.  I hope that this is not a bother, but if you wouldn't mind, could you possibly give me an idea of any risks involved with not doing surgery on an unresponsive or persistent Chalazion?  I guess I am fuzzy on whether it is a strictly cosmetic issue, or if there are other reasons one would need to do surgery at some point.  

[John C Hagan III, MD, FACS]

It is not a cosmetic procedure. The risks of scarring or deformation are very small. With time almost all chalazia quiet down and become a hard little knot under the skin that usually cannot be seen. It's must the most adults don't want to wait for somehting thats pretty gross looking to get better over 3-6 months.

JCH III MD

[jessia]

Hello,
We have been doing compresses, and the chalazion has not changed much over the course of the last month.  Today we picked up our daughter after her weekend with her grandmother and it looked crusted over.  I just put a warm wash cloth on it and cleaned it with sterilid, and under the crusty stuff, it looks like three giant whitehead zits.  It is a bit more red than usual.  Do you think that this is a problem?  i.e. does this warrant a sunday call to our pediatric optho?  It looks like they are going to pop.  

[John C Hagan III, MD, FACS]

No call the office tomorrow and use the warm compresses.

JCH III MD

[jessia]

If it ruptures, is that bad?

[John C Hagan III, MD, FACS]

No it can actually help it go away faster.

JCH III MD

[jessia]

Thank you so much for your help.  It indeed ruptured, and we went back to our Pedi Optho, who was extremely curt with us.  He basically indicated that he wanted to do the surgery, and since we chose to wait, now she will have a scar from the rupture.  Personally, I am happy that she did not have to be subjected to a surgery for something that now looks like it will be at most a 1/4" scar.  
It has gone down in size quite a bit, but remains swollen to a degree.  Do they generally drain for a long period?  Will keep you posted, and again thank you very much for your guidance.  

[John C Hagan III, MD, FACS]

It is very very unusual for a chalazion to leave a noticable scar.  I would continue with the warm compresses and cleaning lids with TheraTears SteriLid eyelid cleaner (over the counter).

I would also consider finding a new ped ophthalmologist. You don't need "curt".

Find one at www.aao.org

JCH III MD

[jessia]

To give an update, I took your advice and found another Ped Optho (Dr. Gearinger at Strong Memorial Hospital), and he was wonderful.  We ended up doing the surgery Monday, as our new Dr. indicated that he thought the chalazion had some fibrous tissue that had formed.  He did the procedure with laughing gas, rather than having to intubate and do IVs (which is what the other Doctor was adament about doing).  It really went tremendously well.  It was such a non-event for my daughter.  She was totally unphased by the experience.  All in, we waited 5 months to do the procedure, and I am glad we waited, as I did not want to put her through anything unecessarily but it was not as bad as I had anticipated.
Thank you again for your help.  Maybe this series of posts will help some other parent in the future.

[mjeleven70]

I have a chalazion that just ruptured as well.  I was wondering if using the occusoft eyelid wipes would be good enough to keep the lesion sterile.  Also, what would be your opinion on using some sort of topical ointment to prevent scaring (neosporin etc.)?

Thanks so much for your timely replies, you are doing a great help to all of us on this site, thats for sure.

[John C Hagan III, MD, FACS]

You can't keep it sterile. You need to keep it clean. Warm water, occusoft wipes and Occusoft foaming lid cleaner will work nicely.

A topic antibiotic would  be helpful. I believe the best are E-mycin or bacitracin. Neosporing would be a second choice, about 10% of people develop a rash from the neomycin.

Use the search feture and read about chalazions and also read the section at emedicine.

JCH MD

[Rouss1]

Hello, I am the mother of a child who has had numerous chalazions from the time he was about 2 1/2 or 3 years old, he is 5 1/2 now.  He has had one surgery where they removed 5 at one time and removed necrotic skin that had been left as a result of the chalazions.  We did a three month period of antibiotic and antibiotic gel in his eyes.  We have gone awhile now without having any chalazions (maybe 6 months) until today when he woke up with a new one.  The pediatric optho. I have been going to just keeps telling me there is really nothing more I can do but wash his eyes better.  I have two other children and I have been washing all of their eyes the same way and the other two have no issues.  I have never been told about the TheraTears so I am going out in a few minutes to buy those but other than that can you suggest I do anything else?  I am at my wits end, people are so hurtful and stare and actually have the gall to come up and ask questions about it while we are in the store, hopefully this new one wont get to that point.  My little boy is already upset enough and says that on Tuesday he will have to explain to his new friends at school why he has a "freaky eye".  Thank you for any info you can give.  
P.S. Jessia--I actually took him to one ped optho who told me the chalazions were normal and scolded me and my 3 year old for not doing warm compresses 3 times per day for 15 minutes on each eye.  So I feel for you with the "curt" doctor and am glad you found one you like.  
Thanks,  Gina

[John C Hagan III, MD, FACS]

I'm sure this is very difficult for you and your child. It is definitely not normal. However when I was doing pediatric ophthalmology there were kids that had a lot of these. Unfortunately its dangerous to use oral tetracycline in children and of course surgical removal is usually a general surgery event.

It has nothing to do in my opinion with not washing the kids hands or getting dirty. My two grandchildren are here with me for Labor Day and they are covered in dirty most of the day.

Instead it more of an oil gland problem just like Acne.

Be sure to keep hair cut short, no long bangs. Use TheraTears SteriLid foam cleaner OR Occusoft Foam lid cleaner. You can see which one you like or works best. Both are over the counter. Also Occusoft makes small medicated pads to wipe the lids with during the day to remove oil and debris.

Hope these help.

JCH MD

[Rouss1]

I want to thank you for your help.  After I got your message I went to the store and bought the TheraTears.  I dont know if it was a coincidence or if the cleaner works wonders but with in a few days the chalazion was gone.  Why is it that his regular ped opthomologist has never mentioned this to me?  I doubt this is a new thing.  My son says it stings so I dont have him use it regularly, maybe everyother day but it seems to be working for us.  I hope this will have been the last chalazion he ever has.  Thank you!  Also thank you for taking the time to respond to me while you had your own grandchildren there.....it truely shows your dedication.  
--Gina

[John C Hagan III, MD, FACS]

Thanks for the follow up. If it stings too much try the Occusoft Foam Eyelid cleaner and also try the eyelid cleaning pads they make. Also over the counter

Next time you're in to see the peds ophthalmologist tell them about your experience with the two eyelid cleaners.  Doctors can learn from their pattients also.

JCH MD

[lio]

how you doing sir. My daughter is 20 months old. shes had this problem calazia for over 8 months now. the lump has gone away but every once in a while they appear again but small little onces on the top and on the bottom of the eye lids (inside). we have seen the doctor atlest 5 times already and have been doin the warm compresses. It goes away for a while but then it comes back, just seems like there is no end to this. what worries me even is that my daughter has been rubbing her eyes alot and she is getting real sensitive to light specially the sun light. its starting to get real bad and even during night time if we turn on the lights she clses her eyes because it bothers her, this happened for about 2 days now so im gonna take her to the doc, but in the meantime can u give me some advise or direct me to any specialst in the area of san diego ca. note: her eyes get red every once in a while it will last a day or 2 and then go away. do you know of any eye drops that i can get over the counter for her to treat the light sensitivity? im am very desperate and sad to see my daughter this way please help us.

[John C Hagan III, MD, FACS]

Go to www.aao.org and look for a pediatric ophthalmologist near where you live. Read the many posts about this problem (chalazia) in children. Be sure you are using Ocusoft easy clean pads and their foam eyelid cleaner.

JCH MD

[lio]

thank you very much, will try the ocusoft easy clean pads. I already scheduled an appointment for her aphthalmologist and she says it might be a condition called Blepharitis.She is scheduled for monday so hopefully everything will be fine. I will continue with the warm compress, and try out the ocusoft clean pads.Thanks for all ur help.

[John C Hagan III, MD, FACS]

You're welcome
JCH MD

[dayanis]

Hi, my name is Diana I have a 2 yr old daughter, who has chalazia in both eyes, she got 2 in the right eye and one in the left one, one of the chalazion in the right eye just ruptured last week and Im fine with it because is smaller now and it looks like starting to heal, but the other one in the same eye just got the white head and it seems like it started to rupture but this time is inside the eye, so im little concerned about it, is this dangerous for her?, my opht suggested a surgery finally after 5 months (she is schedule for next thrusday), is she going to be ok until that?, does she still need a surgery after their rupture?, what should I keep doing? thanks so much

[John C Hagan III, MD, FACS]

Chalazions are not dangerous. Read this discussion thread to see what you can do. Chalazions are not filled with pus like styes the material is grissle-like and has to be curretted out.

If the lesion doesn't get much better then proceed with the surgery. if its gets dramaticallly better let the surgeon know.

JCH MD

[mom22BK]

I have a 4 year old daughter with chalazia (started like 2 weeks ago), it developed (we helped with warm compresses) , and popped but the pus also had blood...last friday at school a kid hit her eye accidentally and  she bled, and they cleaned her, the ped gave my erythromycin 4 times a day but is it normal to have blood? do I have to go see a different doctor ? I've been through sleepless nights since I'm so worried... thanks for your help

[John C Hagan III, MD, FACS]

Yes, do see an opthalmologist Eye MD physician. In the USA find one near you at www.aao.org or ask your pediatrician to refer you. I am most concerned about the blow to the eye and to be sure the eye was not damaged. Yes some chalazion when they drain will drain some bloody material.

JCH MD

[JCDC]

I have an 18 month old girl.  She had a lump under her left eye for 2 months.  The opthamologist said it was a chalazion and suggested surgery.  She had the surgery 2 weeks ago.  The opthomologist said it was filled with blood.  Now 2 weeks after the surgery it looks the same as it did before the surgey.  
Is it unusual the a chalazion would be filled with blood?
Should I be concerned?
Do you have any suggestion for the next step?
Thank you for your time!

[John C Hagan III, MD, FACS]

A chalazion by definition is filled with blocked oil that sets up an inflammatory reaction. By two weeks it should be looking better but probably you won't be able to decide how much it helped for another month.

JCH MD

[my2peaches]

My 5 year old daughter started getting Chalazion cysts at 4 years old (back in August of 2008)  She has had 3 in the last 4 month's alone. The first one went away on it's own, the next one lasted for 11 weeks and would not respond, started getting infected and needed surgery.  The one she has now looks worse than the other 2.  It is on the same eye as the recent surgery.  My inital thought was that they did not get it all during the first surgery, however the specialist claims it is in a different area.  Regardless, they are recommending surgery for this one as well.  We are washing her eyes with Johnson and Johnson baby shampoo daily, doing hot compresses twice a day with a hard boiled egg ( we were told these were best as they fit the eye socket and the heat last longer).  Is there anything more we need to be doing?  I am not excited about the 2nd surgery,but I am going off the doctors recommendation as we have tried everything else and it is not responding ( We used Spetra as it appeared infected, hot compresses, tobradex ointment, washing daily).  I am at a loss as we seem to try everything to make them go away and they just keep getting worse. Her 2nd chalazion extraction is scheduled for next Thursday.  Also, she reacted badly to the anesthesia, is there something we can ask about to make it easier for her?
Any insight you can provide would be appreciated.  

[John C Hagan III, MD, FACS]

There are 40-50 large oil glands on each lid so unfortunately thater are as many as 200 glands that can get blocked and get inflammed or infected.

My suggestion would be to use Occusoft foam eyelid cleaner instead of baby shampoon and also Occusoft medicated pad/wipes to clean the edge of the lid.

An acceptable substitute would be TheraTears SteriLid foam eyelid cleaner.

These work much better than baby shampoon.

As for the anesthesia the anesthesiologist should be alert and should review the anesthesia record and perhaps can use a different medication or different dosage for the second procedure.

Keep the scalp well shampooed and oil free and no bangs that transfer hair oil to the eyelashes.

Erythromycin ointment or bacitracin ointment are good for long term therapy and contain no steroids and cost about $4-5 at Wal-Mart.

Good luck.

JCH MD

[tialeann]

My 5 year old daughter is on her second chalazion.  The first one faded after about a year and close to the time that one was gone, another one appeared on her opposite eye.  The first one was on the right lid and seemed to be more towards the surface.  This chalazion is on the left lower lid and was quiet hard and under the skin.  Today about 2 months into  it, I noticed drainage when she woke up.  I looked under the lid and noticed alot of pus and a huge pimple formation.  It looked as though the chalazion surfaced and ruptured.  I am happy about this although her eye ball looks very red and irritated and she has alot of bumps inside her lid in the corner.  My question is this.  Is the pus contagious and should her eye be red and have bumps.  Please help.

Thank you

[John C Hagan III, MD, FACS]

Chalazions can get infected and that seems what has happened. See you eye MD. Read all the posts in this topic.

JCH MD

[aabir]

Hello!
My two and a half year old son has developed a chalazion in both eyes. The first time we thought it was a stye and so did not do much for about five days. When it came up in the other eye too we took him to an eye doctor. He advised us to do hot compresses 4 times in a day, an antibiotic eye drop and an eye cream. We did it religiously, but nothing really changed except that the second chalazion did not become as big as the older one. We met his peadiatrician yesterday, who asked us to stop doing the heat fermentations immediately, coz they dont really help. He asked us to just leave it alone. We have followed his advice... but I am clueless what the next step is. The chalazion is about the size of a ball bearing. It seems to not trouble my son at all. Please advice our next course of action.

[John C Hagan III, MD, FACS]

This subject is covered in this posting and you can use the search and archives to read the many detailed discussions of the frustrating problem.

JCH MD

[sarahc27]

Hello,
I just recently had my chalazion surgery done on April 6, 2009 on my left eye for both the upper and lower lid.
The upper lid no longer has a lump but it looks drasticaly different form the other eye and it is also discoloured (dark/blackish)
Am I doomed to look this way for life?

Also, the bottom lid's lump is still there and it has only decreases from it's original size but about 25%. It is actually right in my tear duct area. After the procedure the doctor had a final look at my eye when  but then decided to go back to check something. He said that he thought there was still something left on my bottom lid. As the anesthetic had worn off I started feeling everything and told him I was in pain so she said sorry and he wanted to check something. Then he stopped after I had complained a second time about the pain.

It seems to me that the job was not finished. If so, would I be able to have a second surgery? If yes, how long do I have to wait for that?

Thanks in Advance.

Sarah.  

[Escudero]

Dear Dr Hagan,

Thank you so very much for this webpage. We live in Sydney, Australia and for the last 2 months, my husband and I have been watching how our 18 month old girl develops these horrible chalazia. She has had them in several places (upper and lower eyelid, left and right eye). We have used (and currently using) Chlorsig eye ointment as prescribed by the doctor. It seems to work but only for very little time. We have not being to a Paed. Opthalmologist as there is at least a 3 month waiting list (her appointment is late Jan 2010). You suggested the use "Occusoft Foam Eyelid cleaner" should the TheraTears SteriLid eyelid cleaner sting too much. This may be a silly question, but would you know the equivalent in Australia? Or the ingredients it contains so I can find a similar product. I have taken my daughter to see a doctor and an orthopist and none suggested the product (TheraTears SteriLid eyelid cleaner). Is it ok to use it on my 18 month old?
Thanking you.