Operation on a hailstone

The hailstone, also known as chalazion in technical terms, is a chronic, inflamed area on the eyelid caused by certain blocked sebum glands, the so-called meibomian glands.

How does a hailstone come about?

The 20 to 30 meibomian glands are distributed throughout the eyelid and their ducts end at the edges of the eyelid. If you pull the edge of the eyelid forward a little, you can see them as small, yellowish dots arranged next to each other.

If an outlet duct of the meibomian glands becomes blocked, the sebum produced in the gland can no longer drain away and builds up. The body's own defense cells recognize the sebum and try to eliminate it. Ultimately, the gland becomes inflamed.
The inflammation is visually noticeable as a small thickened area, usually a few millimeters in size and shimmering very slightly purple. Although it is not painful, it is perceived as annoying and unpleasant, especially from a cosmetic point of view.

Causes of the formation of a hailstone

There can be many reasons why a hailstone occurs. For example, an inflammation of the eyelid margin (a so-called blepharitis) can prevent the secretion of the glands from flowing away, as can chronic conjunctivitis. Diseases in which the sebum production of the gland itself is affected can also be a possible cause, for example acne or diabetes mellitus. In extremely rare cases, a tumor on the lid can also cause the duct to become closed and the secretion to accumulate due to its growth in size.

diagnosis

The diagnosis "Hailstone“Is set very easily and quickly in almost all cases. The (ophthalmologist) doctor examines the affected eyelid and scans it. If the examination can be carried out without problems and, above all, painless, it is the said hailstone. However, if pain occurs and the area is not just a little pale purple in color, but rather reddened, it is more likely to be a Barley grain, also Hordoleum called.

Treatment of the hailstone

How can you treat the hailstone now? What are the options? In principle, you can treat hailstones conservatively or surgically. Conservative means that you try to get a problem under control with ointments, tablets, etc. Operationally, however, that you carry out a surgical procedure on the body.

Conservative treatment

In the case of a chalazion (the hailstone), the conservative approach means trying to curb the inflammation of the sebum with anti-inflammatory eye pots or eye ointments / creams and to make it easier for the body's own defenses to reduce the inflammation. Dry heat, such as exposure to a red light lamp, can sometimes be helpful and accelerate the healing process. It is also possible to inject cortisone into the affected area, which also has an anti-inflammatory effect and leads to decongestion and the disappearance of the reddening of the skin.

Operative treatment

If it is a rather large hailstone or if all other treatment attempts that have been made so far have not worked, there is still the option of surgical intervention. That sounds dangerous at first, but in the end it is a very harmless thing and routine at the specialist doctor.

Preparation for the operation

Before the operation can be carried out, the patient must of course first be examined thoroughly. This includes a good medical history (asking the patient about their previous medical history).
Also will

• an eye test with visual acuity determination carried out,
• With the help of the slit lamp, the anterior segment and the fundus are examined as well
• the intraocular pressure is measured to prevent possible complications.

Procedure of the operation

The hailstone operation itself is then only a very minor procedure that is only performed under local anesthesia and not under general anesthesia. The affected area is numbed with an anesthetic injection so that the patient will not feel anything from the procedure. With a holder specially developed for such purposes, a so-called chalazion clamp, the eyelid is folded slightly outwards and the hailstone is firmly fixed in a favorable position. A small incision is then made over the inside of the eyelid exactly above the swelling, perpendicular to the edge of the eyelid.

As soon as the hailstone has been surgically opened, the surgeon can scrape out the contents of the chalazion with another, specially made instrument and remove it completely.
You do not have to worry that parts of the material the eyelid is made of may be removed with it. The accumulation of secretion, which was the cause of the inflammation, is located in a space that is encapsulated by the body's own weaning processes and can be easily distinguished from the rest of the tissue and also separated mechanically. The capsule itself is then removed as much as possible to prevent any new build-up of sebum secretion.
Since it is such a small incision on the surface of the skin, it is not even necessary to sew it up - the body does the closing all by itself and much better than you could with a needle and thread.

To prevent bacteria from settling and causing problems, an antibiotic ointment is applied after the operation and an eye bandage is put on, which should remain on the eye for the day of the procedure.
After that it is already over, the patient can now be discharged home without hailstone and symptom-free. Long-term impairment is not to be expected. As a rule, you can go about your usual job the next day, but the lid itself remains slightly swollen and / or reddened for a few days.

What is the follow-up treatment like?

An antibiotic eye ointment is prescribed as follow-up treatment, but the patient can apply it himself. The material removed during the procedure is securely packaged and sent for histological, i.e. tissue microscopic, examination. So you can be sure that it was actually just a hailstone and not another, similar-looking disease.

What risks are to be expected?

Major complications during or after the operation are not to be expected. Sometimes there may be light bleeding during the procedure or postoperative bleeding, an infection is also possible in principle (but this is also very unlikely due to the antibiotic treatment afterwards). Of course, it cannot be ruled out that the eye itself could be injured or that a nerve or the lid could be affected. However, all of this is very rare and only of statistical relevance.
The removal of a hailstone is therefore a fairly straightforward affair and an absolute routine in everyday ophthalmological practice.

However, it is not uncommon for a hailstone to reappear after a while, which may then have to be surgically removed again. Especially if the patient suffers from skin or metabolic diseases, such as acne or diabetes mellitus, the risk of a new chalazion is greater than in the normal population.

Swelling and pain after surgery

Swelling of the eyelid and pain immediately after the operation are completely normal. Through the mechanical manipulation during the operation, messenger substances are released in the surrounding tissue, which cause both swelling and pain. This is part of the healing process and is, so to speak, a protective mechanism for the body to leave the affected area alone.

Duration of a hailstone

Despite the unpleasant side effects such as swelling, discoloration and cosmetic blemishes, a hailstone in and of itself does not require any further treatment. It usually disappears on its own after a few days without any medical intervention. Sometimes you have to be a little more patient, especially if the hailstone is quite large. Then it can take a few weeks until the inflammation has completely healed and the hailstone has disappeared.
If, however, there is still no improvement in the swelling, the ophthalmologist should be consulted again and the next steps should be discussed again. Because patients who carry such a hailstone around with them for a longer period of time must expect that the skin in the affected area can thin out a bit, which in turn leads to a reddish discoloration of the skin. In addition, the following rule of thumb applies: the longer such a swelling (especially if it is a large one) persists on the eyelid, the longer the pressure on the eye itself, even if only slight, is not negligible its cornea, which in the long term can impair the patient's vision.

Healing time after the operation

An operated hailstone usually heals very quickly. During the operation, the inflamed tissue was removed and the accumulation of secretions removed. Immediately after the operation, the eye may still be red and / or swollen. Wound pain is also normal, after all, some healthy tissue is always injured during an operation. However, if these symptoms persist, you should definitely see a doctor.

Cost of the hailstone surgery

As a rule, a hailstone heals on its own within a few weeks. Surgical treatment is therefore only paid for by the health insurance company if there is a medical need.
Doctors usually offer the surgical removal of the hailstones as an individual health service (IGeL), for the costs of which the patient must pay independently. These amount to around 50 to 90 euros per eyelid, depending on the complexity of the operation.