Clinical features, treatment outcomes, and risk factors for surgery in pediatric chalazion

Purpose: To evaluate the clinical presentation, treatment outcomes, and baseline predictors of surgical intervention in a large cohort with pediatric chalazion. Methods: This retrospective observational study included children (<18 years) diagnosed with chalazion between January 2017 and December 2024 with a minimum follow-up of 21 days. Initial treatment consisted of hot fomentation and topical antibiotics. Clinical resolution was defined as complete disappearance of the lesion without the need for surgery. Survival analysis and Cox regression models were used to identify risk factors for surgery. Results: A total of 471 eyes from 470 children were included (median age: 6 years). Of the 414 eyes initially managed conservatively, 380 eyes (91.8%) resolved without surgery within the first 6 weeks. Surgical intervention was required in 90 eyes (19%), including 56 advised at baseline. Kaplan–Meier analysis showed that among those requiring surgery, most underwent the procedure within 60 days of presentation (cumulative risk at 2 months = 23%; 95% CI: 17–29%). Children who underwent surgery were significantly older (9.7 ± 4.9 vs. 6.9 + 4.4 years, P < 0.001) and had longer symptom duration (median 60 vs. 30 days, P < 0.001) at baseline. In multivariable Cox regression, only increasing age independently predicted surgery (HR: 1.10; 95% CI: 1.04–1.17; P = 0.0002). Conclusion: Most pediatric chalazia resolve within 6 weeks of conservative treatment. Increasing age at presentation was the strongest predictor of surgical intervention. These findings support a time-bound approach to conservative management and highlight the need for prospective studies exploring adjunctive therapies and systemic risk factors.