Eyelid cysts a.k.a. chalazia or styes

Most of the time, cysts of the eyelids or ‘bak chiam’ (in Hokkien) are caused by blockages of the oil glands inside the eyelids. When the openings of these glands are blocked, the oil produced by the gland cannot be released, and it builds up to form a lump in the eyelid.

The white dots are blocked oil gland openings

Oil collects inside the blocked gland, causing a lump to form

Commonly, it feels like a little pea, which can be painful if it gets infected. These cysts are also called ‘chalazion’, and they are very common. They can be associated with inflammation of the eyelids called ‘blepharitis’. Normally, most chalazia are not serious and many do go away on their own with time. Big ones near the middle of the upper eyelid can cause blurring of vision by pressing on the cornea/window of the eyeball.

Problems with these cysts arise especially when they do not go away after a long time, or if they keep coming back. Big cysts that do not resolve on their own are easily treated with a 5 minute office procedure to drain the oil from the blocked oil gland.

Cysts usually happen individually, and then disappear for long periods of time. On the other hand, a smaller proportion of people get cysts that go away and then come back, often in another eyelid or even on the other side. Recurrent cysts are usually associated with ongoing eyelid inflammation. For many people, hot compresses at night followed by eyelid cleaning (perhaps with products such as Lid Care/Blephagel) are helpful in reducing the chances of recurrence.

Very stubborn cases may be related to changes in the eyelid oil to a very thicky waxy material which blocks the channels of the glands. It is thought that these changes are related to the type of bacteria living on the skin of that person, which can also change the normal oil to other irritating substances.

Treating chalazia

The simplest measure recommended is hot compresses, with which we hope to make the oil more liquid and to flow out better.

It has been found that long courses of certain antibiotics from 1 month to several months help to resolve many of these blepharitis cases. Besides their antibacterial action, antibiotics in the tetracycline class also have anti-inflammatory properties. Besides antibiotics, taking Omega 3 oils in the diet or via supplements also helps to reduce the thickness of the eyelid oils and to reduce inflammation in the body.

Oil in some of the glands has turned into a thick material like toothpaste. In some other glands, the oil remains liquid and comes out as little droplets.

Recently, it has also been reported that some people have an overgrowth of skin mites in the eyelids. An article in the American Journal of Ophthalmology (Am J Ophthalmol. 2014 Feb;157(2):342-348) found that more patients with chalazia had these mites, and that patients found to have these mites had a higher chance of cyst recurrence. I routinely check for the presence of these mites in patients with inflammatory eyelid problems, and start treatment against them if necessary.

Pulling gently on the eyelashes causes the white tails of the mites to poke out. They can be teased out onto the eyelid surface and then scooped up with forceps.

One mite having a stroll across the microscope slide...

If despite simple measures the cysts persist, then a simple incision and drainage procedure can be performed in clinic. This usually take 5 minutes or less, after which the eye is padded for 2-3 hours.

Can these cysts be anything more dangerous? Very rarely, yes. There is a rare oil gland tumour that can present like a cyst. If a cyst keeps recurring in the same place, and especially if it is gradually getting bigger or associated with adjacent loss of eyelashes, the doctor should consider taking a specimen and sending it to the laboratory for further examination. But this is a rare condition and is unlikely if the recurrent cysts are happening in different places.

To summarise, do consult an eye specialist, as sometimes prescription medicines like antibiotics or other treatments may help. Dietary changes like taking more Omega 3 oils also would be good, and in the meantime continue with hot compresses and keeping the eyelids clean.