Hailstone

Synonyms in a broader sense

Medical: Chalazion

English: chalazion

Definition of hailstone

A hailstone (chalazion) is a chronic, i.e. permanent, inflammation of a meibomian gland. Meibomian glands are located on the inside of the eyelid. Your secretion provides the fat layer of the tear film. These glands are used to produce sebum, which is used to build up the fat layer.

This disease is consistently benign and harmless!

Illustration hailstone

In the picture you can see the painless thickening on the upper song, which is a hailstone.

We would like to thank Mr. K. B. for providing this picture!

We are also happy to take pictures from other of our readers who, through their pictures, represent added value for our site.

What is the difference between hailstone and stye?

Both the hailstone and the stye appear as red, swollen nodules on the eyelid. But there are a few differences. As a rule, hailstones are more common in adults and less often in small children or children. A stye can occur equally often at any age. The development of the hailstones and the stye are different.

A stye can develop from bacterial inflammation. Instead, a hailstone is created by a blockage of the duct of the sebum gland on the eyelid and is a chronic inflammation with nodular accumulations of cells. A stye is usually triggered by bacteria, a hailstone is not. A blockage of the sebum duct and thus a hailstone can result from a stye.

Another difference is that the stye is painful, while the hailstone usually does not hurt. A recurring stye can indicate diabetes mellitus. A hailstone can also be associated with a metabolic disease such as diabetes mellitus. It remains to be seen whether this is often the case with hailstones that have arisen from a grain of barley. Both hailstone and stye are bothersome, but harmless and usually disappear spontaneously. However, in comparison, a stye usually regresses faster than a hailstone. In both cases, warmth has a soothing effect and sometimes surgery is recommended.

More information can be found here: Stye - what to do

Recognizing a hailstone

What are the symptoms of a hailstone?

This tough lump develops very slowly and is completely painless. Apart from the cosmetic impairment, there are no complaints. Sometimes those affected also report an uncomfortable feeling of pressure. However, conjunctival involvement is rare.

The knot is usually just below the edge of the lid and can be the size of a grape seed or a hazelnut seed. It cannot be moved under the skin.
Hailstones are almost exclusively observed in adults.

Read more on the topic: Eye pain

How is hailstone diagnosed?

The ophthalmologist will first examine the lid region with the help of the slit lamp.
In order to be able to assess the eyelids from the inside as well as from the outside, the eyelids must be ectropioned. Ectropioning means folding down the lid so that the inside faces out.

Differential diagnosis ("Which disease is still in question?") Should be thought of a stye, which, however, is very sensitive to pain.
Further information on the subject can be found at: Stye

Also a rare cancer of the meibomian glands (Sebum carcinoma) must be excluded.
This is a tumor that, if discovered too late, can even be fatal.
Read more on the subject at: Sebum carcinoma

Treating a hailstone

How is a hailstone treated?

In most cases, hailstones are harmless and do not require any special treatment, as they often resolve on their own within a few weeks. Small hailstones in particular, which cause no or only slight discomfort, regress without therapy. The measure of first choice is daily eyelid hygiene and care. The aesthetic aspect is often in the foreground when a treatment is desired.

Since hailstones are often accompanied by inflammation that causes pain or discomfort, anti-inflammatory or antibiotic eye drops or ointment can be used to relieve redness and swelling. In addition, the build-up of secretion can be lifted and the healing process accelerated through gentle heat treatment, for example with the help of a red light lamp (two to three times a day for about ten minutes). When using red light, make sure that your eyes are well closed and that the distance to the lamp is maintained. A similar effect can be achieved with clean, moist, warm compresses that are placed on the closed eyelids for a few minutes. Regular massages of the hailstone, in which one massages with clean fingers in circular movements towards the eyelid, can also help treat the hailstone.
Tablets are not helpful in most cases.

How is a hailstone removed?

The removal of the hailstone should definitely be left to a doctor.
When removing by pure "express“Of the hailstones, the pus bladder with all its bacteria can be pressed into the bloodstream behind it. The bacteria then migrate through this to the head and neck area and can cause serious complications such as meningitis or neuritis.
When the hailstone is surgically opened, a small incision is made in the front. Through this, the pus secretion can easily flow away without additional pressure. However, a scar is not to be expected:
Since the cut is only in the millimeter range, the wound appears more like a mosquito bite after healing and is no longer visible after a few days. In addition to surgical treatment, an antibiotic ointment or - in severe cases - systemic antibiosis is usually prescribed for removal. This prevents the pathogens from spreading in the body.
In principle, any general practitioner or dermatologist can perform a removal, as this is a very minor procedure. The procedure, including healing, is completed in 1-2 weeks. However, it does not protect against recurrences, so unfortunately a recurrence cannot be ruled out.

Can a hailstone also be operated on?

A short operation under local anesthesia can be useful if the hailstone does not resolve on its own under conservative therapy or if it causes severe pain or discomfort. The hailstone is opened with the help of a small incision and the congested and inflamed tissue is removed. A basic ophthalmological examination is usually carried out before the operation so that the respective findings on the eyelid can be assessed and causes other than hailstones for the swelling can be excluded. The operation is performed under local anesthesia that is injected under the skin. The lid is then held in place with a special eyelid holder (a so-called chalazion clamp) and the lid is folded outwards (ectoped). The eyelid skin must be opened with a tiny incision. This can be done either on the outside or inside of the eyelid (depending on the findings). If the eyelid skin is opened from the outside, the wound is usually closed with one or two fine stitches that can be removed after a week. A cut on the inside of the lid usually does not require a seam. After opening the hailstone through the cut, the contents of the hardening can be scraped out with a small, spoon-like instrument. In addition, it is necessary that the capsule of the hailstone is removed as much as possible in order to prevent a new build-up of secretion. After the very short (about three minutes) operation, an antibiotic ointment is applied to the lid and an eye bandage is put on. This can usually be removed on the first day after the operation.

After the minor operation, there is usually no long-term impairment to be expected. Normally, you can resume your usual job the next day. The eyelid may still be a little swollen or reddened for a few days.

In most cases, hailstones can be operated on without major complications. As with any surgical procedure, there is a risk of bleeding or rebleeding and infection. Complications such as eye injuries, nerve damage or distortion of the eyelid due to scarring cannot be completely ruled out, but they are very rare surgical complications.

After surgical removal, the tissue is examined under a microscope. This is necessary because in rare cases a malignant growth can be present instead of a hailstone. By examining the tissue, a possibly causative tumor on the eye can be reliably excluded. If the tissue examination reveals that the finding is different, further treatment measures may be necessary.

Read more on the subject at: Operation of a hailstone

Which ointments help with a hailstone?

As a rule, hailstones regress on their own. However, if this is not the case, treatment with ointments can be used as a support.
An ointment is only useful in the case of acute inflammation or bacterial colonization. If the hailstone has already burst, a wound and healing ointment such as Bepanthen® can be used. In this case, it is important to have a sterile cover to prevent re-inflammation. Bacterial inflammation can best be combated with ointments containing antibiotics, e.g. with Refobacin®.

But ointments containing cortisone also fight inflammation and make the hailstones swell faster. The type and duration of application are based on medical advice. Ointments containing cortisone have the disadvantage of permanently damaging the skin; it becomes leathery and thin. Although this effect is only locally limited to the lid and is reversible, it should nevertheless be mentioned.
Taking antibiotics too often can result in antibiotic resistance.Under no circumstances should the hailstones be expressed, however, as the pus it contains can reach the brain via the bloodstream and trigger a bacterial colonization of the meninges (meningitis).

Which homeopathic remedies help with hailstone?

For some sufferers, homeopathic treatment, in addition to other methods, has a supportive effect. The treatment should be carried out individually and by a specialist with extensive knowledge. For example, Myristica C9 is used. If the pus is present, it can cause it to empty more quickly and promotes faster healing. Pyrogenium C7 and C9 are also used. It can help that the sebum dissolves. It can also prevent pus formation. Hepar sulfuris 15C can be used to minimize the build-up of swelling and pus. In addition, Belladonna C5 can be used to generally relieve pain and swelling. Silicea C4 can also be used to stimulate wound healing in general.

Which home remedies help against a hailstone?

A red light lamp, for example, can be used to support the healing process. The dry heat of the lamp can soften inflammatory processes and support the drainage of secretions. When using the red light lamp, the eyes should be closed and remain closed. Warm, damp towels or washcloths can also be placed over closed eyes for relief. The heat causes the pores of the eyelid to open better and the sebum to break down better. It is not advisable to use self-made solutions or preparations as these are not sterile.

Preventing a hailstone

What are the causes of a hailstone?

The cause of a hailstone lies in a chronic inflammation of a sebum gland in the lid area. If the hailstone is on the edge of the eyelid near the eyelashes, a so-called Zeis gland is affected. A larger lump that is further away from the edge of the eyelid is usually caused by the meibomian glands. These glands give off an oily liquid that mixes with the tear fluid given off by the tear glands. The sebum-like liquid ensures that the tear fluid does not evaporate too quickly. The dried, sebum-like secretion of the Zeis or Meibomian glands is popularly known as "sleeping sand". With chronic inflammation of these glands, one speaks of a hailstone (Chalazion). The chronic, mostly painless inflammation usually leads to a blockage of the gland ducts. This must be distinguished from acute inflammation of the meibomian glands with bacteria (usually staphylococci), which leads to a stye.

How does a hailstone come about?

A hailstone occurs when the ducts of a gland are blocked, as this leads to a build-up of secretion and inflammation of the adjacent tissue. The development of hailstones is favored, for example, by chronic eyelid inflammation (Blepharitis). Blepharitis often occurs together with inflammation of the conjunctiva (conjunctivitis) and can be a result of general skin diseases. The eyelid inflammation manifests itself as sticky eyelids and eyelashes (especially after sleep) and a foreign body sensation. A red, burning or itchy eyelid margin is typical. In this condition, the meibomian glands produce too much sebum (Meibomitis), which can lead to a blockage of the duct and a hailstone. Hailstones are more common in adulthood than hailstones in children.

In addition, hailstones can be caused by skin diseases associated with a malfunction of the meibomian glands. Skin diseases such as acne vulgaris or acne rosacea are also associated with increased sebum production by the glands. Metabolic diseases such as diabetes (Diabetes mellitus) can be the cause of the formation of a hailstone.

In very rare cases, an eyelid tumor can also be responsible for the fact that a gland duct is obstructed and a build-up of secretion occurs, which triggers a hailstone.

Also read: Hailstone from inflammation

How can you prevent hailstones?

There is no way to counteract or prevent the formation of a hailstone.

Course of a hailstone

How long does a hailstone last?

Both the formation of a hailstone and its healing usually take a few weeks each. Some sufferers can be supported by soothing home remedies or, if necessary, homeopathic treatment and the process can be easily accelerated. Touching the hailstone or trying to express it can prolong the course and possibly cause complications. In rare cases, impaired vision or conjunctivitis can occur.

You have to be patient when treating a hailstone, as the regression process often takes several weeks. If there is no improvement, the hailstones need to be treated, as after a long time a larger hailstones can thin the skin and turn reddish in color. In addition, the longer a hailstone is left in the eyelid, the longer a hailstone is left in the eyelid, the risk of visual impairment due to the constant pressure on the cornea Therefore, in some cases, surgery is necessary.

Hailstones can occur repeatedly. In this case, it is advisable to have a doctor determine the cause of the recurrence, as hailstones can also be a sign of other serious illnesses.

What is the prognosis for a hailstone?

The prognosis is good. However, recurrences can occur, i.e. the ducts of the meibomian glands can become blocked again. Here the cause, for example diabetes, should be clarified.

Further questions about hailstone

Is a hailstone contagious?

A hailstone occurs when a sebum gland on the eyelid becomes chronically inflamed. Bacteria are usually responsible for this. However, just like the stye, a hailstone is not contagious, as the pathogens are on the one hand in a closed room and even if the hailstones would open up by themselves, the pathogens it contains are usually not contagious.

The hailstone is a knotty, coarse hardening that can be painful on the one hand but can also trigger a foreign body sensation while blinking.
The diagnosis is usually made by the general practitioner or ophthalmologist through a visual diagnosis. Hailstones usually heal on their own. In some cases a small operation may be necessary. The hailstone is pierced with a small, thin needle. The content then emerges. Prophylactic treatment can then be carried out with an antibiotic ointment or with antibiotic eye drops.

Why does pus develop in or on the hailstone?

As a rule, pus does not form on the hailstones because it was not caused by a bacterial, purulent inflammation. This is different with stye. In some cases, a stye can turn into a hailstone. In the "transition" a collection of pus can arise in the hailstone. In some sufferers, this can be minimized with homeopathic remedies or, if necessary, make it easier to empty the pus.

You might also be interested in: How do you treat a stye? or homeopathy for stye

Can there be hailstones from inflammation?

When the sebum glands on the eyelid, the so-called Meibomian glands, produce increased sebum, the duct can be blocked. Such a blockage of the duct at the edge of the eyelid leads to the body's own enzymes and bacteria breaking down components in the duct. These breakdown products are then transported into the surrounding tissue and cause a granulomatous inflammation the sebum on the eyelid. An immune reaction then takes place on the eyelid.

This creates nodule-like accumulations of cells. These can be seen as a protrusion just below the edge of the eyelid. One feels a grape seed to hazelnut seed-sized knot. Since this is in the cartilage of the eyelid, it cannot be moved. The hailstone is usually painless, as the eyelid's immune response is not caused by bacterial inflammation, but by the body's own degradation products.

Further information on the topic can be found here: Hailstone from inflammation

Can a hailstone develop in a toddler?

Hailstones are less common in small children than in adults. It is usually harmless and doesn't necessarily bother toddlers. However, the toddlers can keep touching it with their hands, slowing the healing process. Treatment with a disinfectant ointment is recommended rather than surgery. Even if the hailstones only slowly get smaller as a result. Surgical intervention is sometimes recommended in adults. However, it is not recommended for small children, as this procedure could cause great stress for the children.

Further information on the topic can be found here: Hailstone in the toddler