Chronic sterile lipogranuloma of a blocked meibomian gland
Overview
A chronic, painless granulomatous swelling from a blocked meibomian gland — a sterile lipogranuloma, not an infection. Follows MGD/blepharitis. Most resolve with warm compresses; persistent ones may need incision and curettage.
Recognise
Painless, firm, rubbery nodule within the tarsal plate, away from the lid margin
May cause astigmatism/blurring if large enough to indent the cornea
Often a history of blepharitis/rosacea and recurrent lesions
Red flags
Recurrent chalazion at the SAME site with lash loss/ulceration → sebaceous gland carcinoma — biopsy
Differentials & how to tell them apart
Hordeolum (stye)acutely painful and infected; a chalazion is painless and chronic
Sebaceous gland carcinomarecurrent same-site lesion with madarosis — must biopsy a recurrent chalazion
Eyelid BCCpearly rolled edge, telangiectasia, slow growth on the lower lid
Chalazion — painless tarsal meibomian cyst
jd / Public domain — Wikimedia Commons
Investigations
Clinical. Histology if recurrent/atypical (exclude sebaceous carcinoma).
Management
Warm compresses + massage (incision & curettage if persistent)
1Warm compress + massage; reassure most resolve over weeks. Treat underlying blepharitis/MGD.Gate:Biopsy/refer a RECURRENT chalazion at the same site (sebaceous carcinoma); refer if it distorts vision or persists
2Persistent/cosmetically troublesome → ophthalmology for incision and curettage (± intralesional steroid).
Warm compresses + lid massage — first-line; promotes drainage of the inspissated gland
Key points
Painless firm tarsal nodule. The exam trap is the recurrent unilateral 'chalazion' that is actually sebaceous carcinoma.
