Summary
Most lumps on the eyelid are benign: a blocked oil gland (chalazion), an infected lash follicle (stye), or a benign cyst of skin or hair origin. They are uncomfortable, sometimes unsightly, and can press on the cornea and blur vision. Surgical management, when needed, is quick and effective.
Who is this for?
I commonly see:
- a chalazion that has not resolved with warm compresses and lid hygiene after 4 to 6 weeks,
- a recurrent stye or chalazion at the same lid position,
- an enlarging or pigmented lesion of uncertain nature (referred urgently to exclude eyelid skin cancer).
Is this funded on the NHS?
Yes, but you have to clear a threshold, and this is the one eyelid operation where every board in England has published what that threshold is. In Hampshire it is Policy 54, and the useful detail is the route rather than the criteria: it is criteria-based access, not prior approval, so nobody has to apply for permission before you are treated. The criteria themselves ask for a chalazion present for six months, plus at least four weeks of warm compresses and lid massage, plus significant interference with vision or with eyelid closure. There is a second route that does not require any of that, and it is the one patients tend not to know about: a lump that has been a source of infection needing antibiotics twice within six months, or that has caused an abscess needing drainage, qualifies on its own. The six-month wording is the common one across England, borrowed from the national Evidence-Based Interventions guidance, but a handful of boards ask for three months instead, so it is worth checking rather than assuming. Suspected malignancy is outside this policy altogether and follows the urgent cancer pathway. It is worth checking how the six-month rule reads in your own area before your referral is written.
What the procedure involves
For a typical chalazion, incision and curettage is performed under local anaesthetic through the inner surface of the eyelid (so there is no skin scar). For a benign cyst on the skin, excision biopsy is performed through a small incision aligned with the natural skin lines.
Most procedures take 10 to 20 minutes and are performed as a day case. The lump is sent for histology to confirm the diagnosis.
Recovery and what to expect
- Mild bruising and swelling for a few days.
- Antibiotic ointment three times a day for a week.
- A small dressing is rarely needed.
- Most patients return to normal activities the next day.
Risks and alternatives
Risks include bleeding, recurrence, mild scarring and infection. The main ‘alternative’ is patience and warm compresses, perfectly reasonable for many small chalazia, which often self-resolve.
Any lesion at all suspicious for malignancy is biopsied or referred urgently; see eyelid skin cancer.