
Overview
This module describes how to incise and drain a Meibomian cyst (chalazion).
Indications
Meibomian cyst with failure of
conservative measuresconservative measuresInstruct the patient to perform twice daily warm compresses (3–5 minutes) and massage (either with fingers or cotton tips) to assist in the release of the chalazion contents. The direction of the massage should be over the lesion, in the direction of the eyelashes.
Contraindications
Uncooperative patient
Large meibomian cysts obscuring vision
In the elderly, where malignancy is suspected
Patient information and consent
Always verify your patient’s identity and obtain informed consent before proceeding.
How do I explain this procedure?
“There is a small swelling on your eyelid because of a blocked gland. We call this a Meibomian cyst. It is necessary to remove it because it can get bigger or become infected.”
What can my patient expect?
“I will place drops in your eye to numb the eyeball and then put a small injection in the eyelid to numb the eyelid. After that I will turn your eyelid inside out, which will not be painful and not too uncomfortable. I will then place an instrument to shield your eye and make a small cut in the eyelid to drain the cyst.”
What is my patient’s role?
“Let me know if you have any allergies, a heart condition, or a bleeding tendency, or use blood thinners. Fearing blood or needles is normal, but tell me if you have fainted from it. Please look up while I instil the drops and while I put the injection into the eyelid. After that, please try to remain very still during this procedure.”
Preparation

Documentation
Patient notes
Equipment
- Sterile glovesSterile gloves
Although it is considered best practice to use sterile gloves to perform minor procedures, there is mounting evidence that infection rates are similar for sterile and non-sterile glove use.
Alcohol-based hand rub
- Sharps containerSharps container
If a sharps container is not within arm's length, use a kidney dish or other hard container to temporarily hold used sharps and to carry them to the sharps container for disposal.
A surgical or waterproof marker
A 3-5 ml syringe, aspiration needle (ideally blunt fill), and a small injection needle
Lignocaine 1% without adrenaline
An alcohol swab
- Topical anaestheticTopical anaesthetic
kept in the fridge
(0.5% proparacaine eye drops)
Dressing pack
Aqueous povidone iodine 5%
Eye drape (optional)
- Chalazion clampChalazion clamp
#11 blade
Scalpel handle (optional)
Small curette
Fine toothed forceps (required if removing pseudocapsule)
Fine scissors (required if removing pseudocapsule)
Cautery (preferable but not always required)
Antibiotic ointment (eg. chloramphenicol 1%)
Two eye pads
Tape (eg. micropore)
Site & Positioning
The patient can be seated in front of you, facing forward with the head preferable against the wall, but it is easier and safer if the patient is lying on a bed facing the ceiling. Always position good lighting on the site, and
magnification
Use a magnifier, magnifier with light or a loupe. If not available, one can use a pair of +2:00 reading glasses. Readers are useful because it leaves your hands free to perform the procedure.
can be useful.
Procedure
Follow medical asepsis with sterile gloves.
Perform hand hygiene.
Locally anaesthetise the eye by instilling topical anaesthetic drops into the eye.
Draw the outline around the lesion with the marker.
Open the suture pack to create a sterile field and pour skin disinfectant into the well. Open the needles & syringe, clamp, curette, forceps, scissors, scalpel blade and dressing onto the sterile field.
Perform hand hygiene and don gloves.
Apply
aqueous povidone iodineaqueous povidone iodineAvoid alcohol based cleaning solutions, because it can cause corneal epithelial damage.
5% preparation to the eye and lids and drape the site.
Ask an assistant to clean the rubber top with an alcohol swab and hold up a bottle of lignocaine without adrenaline. Draw up 2-3 ml. Put the chalazion clamp under the eyelid (between the lid and the eye) to protect the globe against accidental penetration, and infiltrate lignocaine into the
subcutaneous tissuesubcutaneous tissueTo avoid penetrating the globe, infiltrate just below the skin surface and ask the patient to look away from the injection site. Smaller chalazia can be marked cutaneously with a waterproof marker before infiltration to ensure they can be readily located as injection of local anaesthetic distorts the anatomy.
surrounding the chalazion.
Insert the chalazion clamp with the ring on the tarsal conjunctival side and the solid part of the clamp on the skin side of the eyelid.
- TightenTighten
If the patient can feel pain from the clamp, further infiltration of local anaesthetic may be required.
the clamp to restrict bleeding, and evert the eyelid to present the conjunctival surface . Take care not to injure or damage the skin or conjunctiva (if the clamp is tightened too much).
Identify the blocked Meibomian gland on the tarsal surface.
Using a #11 blade, make a vertical incision perpendicular to the lid margin into the bulk of the chalazion contents on the
tarsal conjunctival surfacetarsal conjunctival surfaceIf a horizontal incision is made, adjacent Meibomian glands will be damaged. Take care not to involve the lid margin or to penetrate the eyelid to the other side as this will result in scarring.
Most chalazions will be drained through the tarsal conjunctiva.
Only an abscess will be drained through the skin.of the eyelid.
Use a small curette to scrape out the contents of the chalazion.
If a
fibrous wall or pseudocapsulefibrous wall or pseudocapsuleUsually only found in large or chronic cysts. Send the capsule for histology to exclude a malignancy.
When excising, take care not to remove too much of the tarsal tissue, resulting in scarring.
is identified, use the forceps to grasp and then gently excise this tissue using the scissors.
Once the excision is complete, release the clamp. Control any bleeding with direct tamponade, or, if necessary, cautery.
Apply chloramphenicol ointment 1% and a firm double pad to the eye. Instruct the patient to remove the eye pads after 4 hours.
Further instruct the patient to use lid cleaning including hot compression, massage and scrubs in order to reduce recurrence.
Dispose of medical waste safely.
Document completion of the procedure in patient notes.
Troubleshooting
The patient feels pain from the clamp.
More infiltration of local anaesthetic is required.
I do not have a chalazion clamp.
Continue conservative treatment until one can be procured, or refer the patient on conservative treatment.
Risks
Vasovagal response (fainting)
Globe perforation
Canalicular trauma
Haemorrhage
Infection
Lid notching from incision to lid margin
Sharps injury to healthcare personnel
Scarring of the eyelid
References
Gilchrist H, Lee G. Management of Chalazia in General Practice. Australian Family Physician. 2009 May; 38(5):311-314. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499889/
Jordan G, Beier K. Chalazion. [Updated 2021 Aug 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Available from: https://www.racgp.org.au/download/Documents/AFP/2009/May/200905gilchrist.pdf
Pons J. How to treat the eye. In: Mash B, Blitz-Lindeque J, eds. South African Family Practice Manual. 2nd ed. Pretoria: Van Schaik Publishers; 2010:138-139