How old are you? *

Under 18 18 or over

Which eyelid is affected? *

Upper eyelid Lower eyelid Both Not sure

How long has the lump been present? *

Less than 2 weeks 2–6 weeks More than 6 weeks

Which symptoms are you experiencing? *

Firm lump in the eyelid Localised swelling Mild tenderness Redness Cosmetic concern None of the above

Are you experiencing any of the following? *

Sudden reduction in vision Double vision Severe eye pain Sensitivity to light None of the above

Do you currently have signs of infection around the eye? *

Increasing redness spreading beyond the eyelid OR Pus or discharge OR Fever or feeling unwell None of the above

Have you had treatment for this before? *

Warm compresses only Antibiotic ointment or drops Steroid injection Previous chalazion surgery No previous treatment

Do you have any of the following? *

Bleeding or clotting disorder or taking blood-thinning medication (e.g. warfarin, DOACs) Diabetes None of the above

Please confirm: *

All patients are assessed before any treatment is offered.

I understand that I will be assessed first and surgery is only performed if clinically appropriate

Anything else you think we should know?

you can leave blank if not required

Results

Next Steps

Thank you for completing the screening questions. Your responses help us prepare for your appointment. All patients are assessed in person before any treatment is offered.

You will now be taken to our secure booking system to choose your appointment time and complete payment.