AbstractChalazion is a common inflammatory condition of the eyelid, usually treated on the basis of clinical diagnosis alone. Preoperative exclusion of malignancy in chalazia with atypical clinical presentation could prevent unwarranted surgery. This is a retrospective study of aspirates from 16 patients with chalazia having an atypical clinical presentation. Smears were stained with May‐Grünwald Giemsa. Two broad patterns of granulomatous inflammation reflecting the spectrum of changes in the course of the disease were seen. Nine smears had mixed‐cell granulomas consisting of neutrophils, lymphocytes, plasma cells, macrophages, giant cells, and granulation tissue. Seven smears had suppurating granulomas characterized by epithelioid cell granulomas with numerous neutrophils in a proteinaceous background. Fine‐needle aspiration cytology of chalazia with atypical clinical presentation provides a rapid, safe, and reliable means of documenting the diagnosis and excluding malignancy. Diagn. Cytopathol. 2004;31:118–122. © 2004 Wiley‐Liss, Inc.