Eye
Eyelid
Inflammatry disorders
Chalazion

Editor-in-Chief: Debra Zynger, M.D.
Pablo Zoroquiain, M.D.

Topic Completed: 25 June 2020

Minor changes: 25 June 2020

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PubMed Search: Chalazion of eyelid [title] pathology

Pablo Zoroquiain, M.D.
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Page views in 2020 to date: 6,019
Cite this page: Zoroquiain P. Chalazion. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/eyechalazion.html. Accessed August 13th, 2020.
Definition / general
  • Very frequent, inflammatory eyelid lesion, characterized by granulomatous inflammation with lipogranulomas
  • All specimens with tissue should be submitted to rule out malignant neoplasms and other masquerading conditions; most of the time they are not submitted
Essential features
  • Very frequent inflammatory eyelid lesion
  • More frequent in the upper eyelid
  • Broad histopathological spectrum from acute to more chronic findings
  • Lipogranulomas, suppurated granulomas, granulation tissue and fibrosing inflammation
  • Can masquerade as neoplastic process
ICD coding
  • ICD-10: H00.19 - chalazion unspecified eye, unspecified eyelid
Epidemiology
  • Incidence and prevalence are unknown
  • More common in younger adults than in children, uncommon in late life
Sites
  • Eyelid
Pathophysiology
  • Probably due to obstruction or nonspecific inflammation (blepharitis) surrounding sebaceous gland ducts, leading to discharge of sebaceous material into surrounding tissue and resulting in intense foreign body granulomatous inflammatory reaction
    • Superficial chalazion from Zeis gland
    • Deep chalazion from Meibomian gland
  • May erupt through conjunctival surface of eyelid (internal chalazion)
Etiology
  • More significant: history of chalazion and blepharitis
  • Less significant: rosacea, gastritis, anxiety and smoking (Cornea 2011;30:1376)
  • There is no evidence that cosmetics in the eyelid causes, aggravates or protects from this condition
Clinical features
  • Upper eyelid > lower eyelid
  • Slowly growing mass with variability in size on a day to day basis
  • Solitary, nontender nodule; eversion helps to identify the lesion
  • Clinically may masquerade as sebaceous carcinoma or other malignancies (Eye (Lond) 2004;18:135)
Diagnosis
  • Typically suspected upon clinical examination
  • Histologic examination of resected tissue can confirm the diagnosis
Treatment
  • Medical treatment includes applying of heat and massage at least twice a day
  • No benefit with antibacterial topical preparations except when infected (hordoleum) (BMJ  2010; 341 :c4044)
  • Surgical management using incision and curettage is a second line of treatment
Clinical images

Contributed by Eugenia Abusleme, M.D.

Chalazion

Gross description
  • Whitish / reddish tissue
Microscopic (histologic) description
  • The key morphologic finding is the lipogranuloma: a central empty optic space surrounded by an epithelioid granuloma with multinucleated giant cells (foreign body type or touton); intergranulomas portion with granulation issue and foamy histiocytes
  • Variable amount of granulation tissue, granulomas with multinucleated giant cells (touton or foreign body type), fibrosis and suppurative inflammation
  • Granulomas can have neutrophilic core when chronic and active inflammation is present, moving towards a more fibrotic lesion when is more chronic
  • Conchoid bodies and asteroid bodies can be observed
  • Reference: Yanoff: Ocular Pathology, 7th Edition, 2014
Microscopic (histologic) images

Contributed by Pablo Zoroquiain, M.D.

Chronic conjunctival inflammation

Large lipogranuloma

Small lipogranuloma

Neutrophilic granuloma

Positive stains
Negative stains
Sample pathology report
  • Right eyelid, nodule, excision:
    • Chalazion (lipogranulomas) (see comment)
    • Comment: There is no sign of malignancy.
Differential diagnosis
  • Steatocystoma:
    • Cystic lesion lined by pluristratified epithelium without granular stratum wavy keratin
    • Some sebaceous gland can be present attached to the cyst
  • Sebaceous carcinoma:
    • Infiltrative lesion with marked cellular atypia and microvacuolar cytoplasm
    • IHC: adipophilin+, CK7+ and AR+
  • Basal cell carcinoma:
    • Basaloid neoplasm with palisades and stromal clefts
    • IHC: EMA-
  • Hematolymphoid neoplasms:
    • Granulocytic sarcoma:
      • Large cells with large cytoplasm and blastoid nucleus
      • IHC: lysozyme+
    • Histiocytic neoplasm (Langerhans and non-Langerhans):
      • Neoplastic process of large cells with reniform nuclei (non-Langerhans) or grooved nuclei (Langerhans)
    • Lymphoma:
      • Cells with high N/C ratio, highly discohesive
      • IHC: CD45+ and CD20+ (B cell lymphoma) or CD3+ (T cell lymphoma)
  • Infectious granulomas:
  • Autoimmune inflammation:
    • Granulomatosis with polyangiitis:
      • Necrosis, granulomas and angeitis present
    • IgG4 related disease:
      • Lymphoplasmacytic infiltrate with storiform fibrosis
      • Lymphoid aggregates
      • Obliterative phlebitis
      • IgG4/IgGt ratio higher than 60%
Board review style question #1

What is the key finding for chalazion seen in this photo?

  1. Exuberant granulation tissue
  2. Fibrosing chronic inflammation
  3. Lipogranulomas
  4. Lymphoplasmacytic chronic inflammation of the tarsal plate
Board review answer #1
C. Lipogranulomas. This is the key morphological finding in chalazion. The granulomas are usually nonnecrotizing. All the other changes such as lymphoplasmacytic chronic inflammation of the tarsal plate, exuberant granulation tissue and fibrosing chronic inflammation could be present but are nonspecific.

Comment Here

Reference: Chalazion of eyelid
Board review style question #2
What is the most common location of a chalazion?

  1. External canthus
  2. Inner canthus
  3. Lower eyelid
  4. Upper eyelid
Board review answer #2
D. Upper eyelid. The most common site of a chalazion is the upper eyelid, followed by the lower eyelid. Canthal location is rare.

Comment Here

Reference: Chalazion of eyelid
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