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