The hailstone or chalazion is a cyst (lipogranuloma) on the upper or lower eyelid caused by the blockage and inflammation of a sebaceous gland (meibomian gland).
The meibomian glands lie at the edge of the upper and lower eyelids (each eyelid has a gland) and release an oily fluid that mixes with the tear fluid.
A hailstone is not a tumor and does not cause permanent visual damage.
The chalazion contains pus and fixed fat secretions (lipids), which normally make the eye lubricating, but can no longer drain.
The hailstone grows in a few weeks and usually does not cause pain or other disturbances.
Rarely, it can grow so large that it presses on the eye and affects vision.
What are the causes of hailstone?
A hailstone can develop when the sebaceous fluid produced by the glands in the eyelids, called meibomian glands, solidifies and can no longer exit the gland.
The sebaceous fluid accumulates inside the gland and bulging thickening in the eyelid.
In the end, the gland can burst and release the sebum into the surrounding tissues, causing inflammation of the eyelid.
There are several causes that can cause blockage of the glandular duct, these include:
- hormonal factors affecting the viscosity of oily secretions;
- lack of hygiene at the edge of the eyelid;
- according to the blood group diet, hailstone and barley thorn are caused by the diet, especially by excessive carbohydrates; after a fasting diet of 2-3 days, the disorder may spontaneously disappear, but there may be a relapse if the patient again consumes cereals, desserts and sugar.
Diseases that can cause a hailstone are:
- Chronic blepharitis, an inflammation of the eyelids and eyelashes
- Seborrheic dermatitis
- High lipid concentration in the blood
- Viral infection
How does a hailstone form?
The hailstone can develop from a stye or form independently.
- As a rule, a stye begins as a red cyst that resembles a pimple on the edge of the eyelid.
- The hailstone may resemble a stye, but usually it is much larger and does not always hurt.
- The stye is caused by a bacterial infection in the follicle (root) of an eyelash that extends to a sebaceous gland.
- With the growth of the stye, the eyelid swells and hurts, in addition, the eye may water.
- Most barley grains swell for about 3 days before bursting, opening and emptying their contents.
- A stye usually heals in about a week.
- After healing, the eye swells, leaving a hard globule of variable size.
- The hailstone forms when a sebaceous gland becomes clogged. If an inner stye cannot drain and heal the liquid, it can turn into a hailstone.
The growth of a hailstone is slower than that of a stye.
What are the symptoms of a hailstone?
The hailstone begins as a cyst or hard lump under the skin of the eyelid.
Unlike the stye, the hailstone often does not hurt.
The main symptoms are:
- Swelling and redness of the eyelid
- Feeling of eyelid heaviness
- Complaints only with a certain size and inflammation
- Blurred vision
Complications of hailstone
Serious complications are rare.
If a hailstone becomes sufficiently large, it can temporarily impair vision or lead to eyelid closure.
A large hailstone can provoke astigmatism by pressing on the cornea, or can lead to mechanical ptosis (drooping of the eyelid).
Inflammation and swelling can spread to the surrounding region of the eye.
Diagnosis of hailstone
Examinations and tests
The ophthalmologist takes the anamnesis and performs a physical examination.
The examination includes an eye test for each eye and an inspection of the face, eyelids and the eyes themselves. In addition to examining the eyelid skin, the ophthalmologist can examine the inside of the upper eyelid to see if there is a lump in this area.
Differential diagnosis, the doctor must exclude the following diseases:
- Preseptal cellulitis
- Orbital cellulitis
- Herpes zoster
- Herpes simplex
- Basal cell carcinoma
- Sebaceous gland tumor
- Scale cell carcinoma
- Merkel cell carcinoma (rare)
- Lacrimal sac neoplasia
How is the therapy for hailstones?
Initially, no treatment is recommended.
In about one person in two, the condition improves without any therapy.
It can take a long time to heal, even up to 6 months.
If it is small and there are no problems, it is certainly best to observe and wait.
You must not press a hailstone like a pimple.
- Hot compresses help to relieve the discomfort. Dip a clean cloth in hot water and press gently but firmly on the closed eye.
This should be repeated 3 to 4 times a day for 5-10 minutes.
Sometimes the heat and a slight pressure are sufficient to soften the contents of the cyst and thus bring about an easier drainage.
The water should be hot, but not boiling.
- Massage of the cyst after the hot poultice can serve to empty the cyst. Perform the massage gently with fingertips or a clean cotton cloth in the direction of the eyelashes.
- Clean the eyelids several times a day to remove grease and dirt that contribute to the formation of the cysts.
A mild children’s shampoo solution in hot water is ideal.
- The doctor may prescribe an ointment with antibiotics and steroids, which is applied to the eye.
- The diet must be changed, especially cereals, desserts and dairy products are to be avoided.
When is surgery necessary?
If the hailstone does not pass after a few weeks or if a recurrence occurs, the ophthalmologist can consider whether the lump should be surgically removed.
Operation of the hailstone
The procedure can be performed on an outpatient basis. This means that you can return home on the same day of the operation.
The operation is performed under local anesthesia (except for children who are sedated). This involves a small injection into the eyelid, which numbs the area (it is the same anesthesia that the dentist uses).
You may feel like something is happening in the operating area, but you don’t feel any pain.
Sometimes a local anesthesia ointment is also used to avoid discomfort caused by the injection.
If the hailstone is relatively small, it can be removed through a small incision in the lower part of the eyelid.
The eyelid is lifted so that the surgeon has access to the posterior surface.
The incision is small (about 3 mm) and is made directly on the hailstone.
The contents are removed by scraping (curettage) and pressure is applied for a few minutes to prevent bleeding from the operation.
As a rule, intervention is carried out through the inside of the eyelid and there is no need for a suture; therefore no visible seam can be seen on the outside.
If the hailstone is large and presses on the skin of the eyelid, a smaller incision is made in the front part of the eyelid for removal.
The cut is also about 3 mm long and is located on the top of the hailstone.
After removal of the cyst, local pressure is applied to it to stop bleeding.
The incision on the eyelid skin is closed with very fine and almost invisible stitches, which show a very good aesthetic result after their removal after five to seven days.
The removed hailstone is usually sent to a laboratory to be examined under a microscope, even if a carcinoma rarely appears.
After the procedure for hailstone
After the removal of a hailstone, most patients have
- Foreign body sensation in the eye.
The eyelid is swollen and will gradually decongest over time.
- The patient is discharged with a bandage, which he can remove after 4-5 hours without having to replace it.
- The eye must be treated with antibiotic eye drops three times a day to prevent infection and swelling of the eye.
- For the pain, the doctor prescribes paracetamol and not aspirin, because the latter could lead to bleeding.
- You can put on the glasses that were worn before the operation, as soon as the bandage has been removed.
If contact lenses are worn, they cannot be worn on the operated eye for eight weeks.
- You can return to light work after one or two days, heavier work/manual work should only be resumed after 7 to 10 days.
- You can wash, bathe or shower normally after the operation.
- For a month you should not make up your eyes.
- Normally, you can return home on the day of the operation.
Complications of surgery are rare, but possible; These include:
- bleeding on the eyelid,
- Eyelid injuries (very rare)
The most common problem is probably a recurrence of the hailstone.
How long does a hailstone remain? What is the prognosis?
Usually, a hailstone passes over the course of a few weeks.
In this case, there are no long-term consequences.
The hailstone is not malignant and has no predisposition to cancerous degeneration. The hailstone is not contagious.