What are the pros and cons for both steroid Injection and surgical removal when it comes to treating chalazion?

Surgery is surgery; it's invasive, aggressive, more expensive and entails a bit of downtime. The simplest approach to a chalazion, and one which I routinely use for my patients and family, is the simple intralesional injection of the anti-inflammatory agent, triamcinolone--the same one used to treat inflamed acne cysts. In most cases, the chalazion will respond to one or two such, relatively inexpensive, little to no downtime treatments spaced about three weeks apart. Just by absolute coincidence, my secretary just informed me that our next patient, a new one, is in fact coming in for treatment of a chalazion. 

The answer really depends on the size/timing of chalazion but in general the cons of steroid injection are that it often doesn't work and can possibly cause fat atrophy and discoloration. I myself have had an eyelid chalazion removed surgically so that is usually the best treatment but again it depends on the chalazion.

The surgeries are often incomplete because the lesion is not often fully excised but rather opened and scraped out.  That can leave residuals inflammatory material. Surgeons are paid on the basis of the complexity of the surgery they perform.  That leads to the temptation of doing a bigger procedure than strictly necessary.  This can be disfiguring. The kenalog (a depot steroid injection) often avoids the need for surgery.  A chalazion is an inflammatory lesion that is very sensitive to steroid.  Most lesions respond beautifully to one or two rounds of kenalog without the need for surgery.  When this option is not fully successful, I have had no problem excisioning the residual lesion surgically but this is seldom necessary.

SURGERY - Pros - immediate and permanent results for that chalazion (can develop chalazia in other glands). Cons - potential for scar. STEROID INJECTION - Pros - slow improvement of the chalazion usually without scar. Cons - once injected it can not be removed, less likely to produce complete results, steroid is often visible through skin.I would recommend maximal medical therapy with oral medication (such as Doxycycline, topical medication (such as erythromycin ophthalmic ointment) and hot compresses - then surgery if medical management does not produce improvement in 4+ weeks. Chalazia are often chronic lesions that can take weeks to months to resolve. Best wishes.