Intralesional triamcinolone acetonide injection versus incision and curettage for primary chalazia: a prospective, randomized study

Immunophenotypic profiles in chalazion and pyogenic granuloma associated with chalazion

PURPOSE

To evaluate immunophenotypic profiles of infiltrating cells in surgically excised tissues of chalazion and pyogenic granuloma associated with chalazion.

METHODS

Eighty-two surgical specimens from 74 consecutive patients newly diagnosed with chalazion or chalazion-associated pyogenic granuloma at Tokyo Medical University Hospital between 2016 and 2022 were studied. Sixty specimens were chalazion lesions and 22 specimens were pyogenic granuloma lesions (from 15 men and 7 women, mean age 36.6 ± 14.4 years). All patients were immunocompetent Asian Japanese adults. Specimens were analyzed by immunohistochemistry and flow cytometry. Flow cytometry was performed using the following antibodies: CD3, CD4, CD8, CD11b, CD11c, CD16, CD19, CD20, CD23, CD25, CD34, CD44, CD56, CD69, and CD138.

RESULTS

In flow cytometric analysis, the proportion of cells expressing the T cell marker CD3 was significantly higher compared with other immune cells expressing specific markers (p < 0.0001), and the proportion of CD4-positive T cells was significantly higher than that of CD8-positive T cells (p < 0.0001), in both chalazion and pyogenic granuloma specimens. The chalazion and pyogenic granuloma lesions shared similar immunophenotypic profile characterized by predominant T cell infiltration, and CD4 T cells dominating over CD8 cells. The pattern of expression of CD4 and CD8 in the specimens was confirmed by immunohistochemistry.

CONCLUSION

The present study demonstrates immunophenotypic features of chalazion and chalazion-associated pyogenic granuloma. Although various inflammatory cells are involved in the pathology of chalazion and pyogenic granuloma, a significantly higher proportion of CD4-positive T cells may be closely related to the pathological mechanisms of both lesions.

Chalazion Treatment: A Concise Review of Clinical Trials

A chalazion is one of the most common eye conditions presenting as a mass lesion of the eyelids. It is seen in all age groups. Chalazion is a non-inflammatory process and develops due to retained secretion of the meibomian or Zeis glands. Treatment of choice differs among clinicians and may include application of warm compress onto eyelids, lid hygiene, using local antibiotic ointment with or without steroids, injecting steroid solution (triamcinolone acetonide) into the lesion and surgical removal of the lesion by incision and curettage. In addition, there are some other experimented methods such as injection of botulinum toxin A, tarsal trephination, removal of chalazion by application of CO2 laser or cryogenic action. However, there is currently no commonly agreed treatment of choice. In this review, we aimed to summarize findings from clinical trials and hopefully, identify a treatment of choice in chalazion.

Extralesional triamcinolone acetonide injection in the treatment of small chalazion

Purpose

To evaluate the effect of extralesional triamcinolone acetonide (TA) injection in the treatment of small chalazion (diameter ≤ 5 mm).

Methods

Prospective interventional clinal study that included patients diagnosed as chalazion of small size not responding to conservative management for at least 2 weeks. All patients were treated with extralesional TA injection (4 mg). Successful resolution of a chalazion was defined as a decrease in size to 1 mm or smaller.

Results

Thirty-eight patients were included in the study. The resolution was achieved in 33 (87%) patients. Nineteen (50%) patients had complete resolution after the first injection, and 13 (34.2%) patients had complete resolution after the second injection. Chalazion near the lower punctum needed more times of injections than those elsewhere (P = 0.02).

Conclusions

Extralesional TA injection is effective in the treatment of both primary and recurred small chalazia. It is a simple and cost-saving procedure and can be considered an alternative first-line treatment for small chalazion.

The Usefulness of Diathermy Thermocoagulation in Chalazion Surgery

Purpose

To investigate the usefulness of diathermy thermocoagulation in chalazion surgery.

Methods

This prospective, observational study included 30 sides from 24 patients who underwent chalazion surgery using diathermy thermocoagulation. The eyelid was fixed with a chalazion clamp under local anesthesia. The skin or palpebral conjunctiva was incised, and the chalazion was partially curetted. The residual chalazion contents were coagulated with diathermy and detached from the surrounding tissues using forceps and scissors. Then, the residual chalazion contents were completely removed.

Results

The chalazion was not palpable in all cases 1 week postoperatively. A small chalazion redeveloped close to the primary lesion 2 weeks postoperatively in one patient; however, it spontaneously improved. No other cases experienced recurrence or complication during the follow-up periods.

Conclusion

Thermocoagulation of chalazion contents using diathermy facilitates grasp, dissection, and excision of chalazion contents.

Randomized Prospective Evaluation of Microblepharoexfoliation BlephEx as Adjunctive Therapy in the Treatment of Chalazia

PURPOSE

Chalazia are benign eyelid lesions caused by the obstruction and inflammatory reaction of the meibomian glands. Demodex mites are one potential cause of chalazia leading to mechanical obstruction of the meibomian gland. In this prospective randomized study, we examine a novel approach to treating chalazia with the use of microblepharoexfoliation (MBE), an in-office lid hygiene technique that exfoliates the eyelid margins.

METHODS

Fifty patients with clinical evidence of acute chalazion were enrolled in this study. Subjects were randomly assigned to a MBE plus lid hygiene group (23 patients, mean age 66.6 ± 16.6 years) or a lid hygiene alone group (27 patients, mean age 62.1 ± 14.4). The MBE plus lid hygiene group received MBE treatment and were evaluated 1 month after the baseline visit. The main outcome measured was the resolution of the chalazion at the 1-month follow-up visit.

RESULTS

The lid hygiene plus MBE treatment group demonstrated a statistically significant resolution of the chalazion compared with the lid hygiene group alone ( P = 0.007; chi-square test). Among the MBE plus hygiene group, 87% of the patients had resolution of their chalazion as opposed to the lid hygiene alone group, which had 44% resolution.

CONCLUSIONS

This is the first prospective, randomized clinical trial that demonstrated efficacy of MBE as a noninvasive adjunctive treatment method for chalazion resolution.

The Lowly Chalazion

Chalazia are localized cysts of chronic lipogranulomatous inflammation arising from the obstruction of sebaceous glands of the eyelid tarsal plate, including the Meibomian gland (deep chalazion) or Zeis gland (superficial chalazion). This disease entity is differentiated from the hordeolum (stye), an acute purulent localized swelling of the eyelid often associated with an eyelash follicle, Zeis gland, or Moll gland obstruction and infection. Ambiguously, the chalazion, hordeolum, and blepharitis are commonly categorized and described on a continuum in the literature. While it is one of the most common eyelid disorders across all age demographics, the chalazion remains largely understudied and pathophysiological, epidemiological, and therapeutic findings exist fragmented in the literature. We discuss current understandings of the chalazion and provide current best practice guidelines supported by clinical anecdotal evidence.

Therapeutic Efficacy and Safety of Intense Pulsed Light for Refractive Multiple Recurrent Chalazia

To evaluate the efficacy and safety of intense pulsed light (IPL) combined with meibomian gland expression (MGX) for the treatment of refractory multiple and recurrent chalazia without surgery or curettage. This was a retrospective controlled study. Patients with multiple and recurrent chalazia, who had performed the conventional treatment at least 2 months without any surgery or curettage, were enrolled in this study. Twenty-nine consecutive multiple recurrent chalazia (12 patients) were assigned to receive either the combination of IPL and MGX or MGX alone as a control. Each eye underwent one to four treatment sessions with 2-week intervals. Parameters were evaluated before and 1 month after the final treatment session. Clinical assessments included symptom, size of each chalazion, lid margin abnormalities, corneal and conjunctival fluorescein staining, meibum grade, the number of Demodex mites, the Schirmer value and meiboscore. All parameters except meiboscore and the Schirmer value were significantly improved with IPL-MGX therapy, whereas only meibum grade was significantly improved with MGX alone. There were no adverse events which occurred in either group. IPL-MGX was safe and effective for multiple and recurrent chalazia without surgery or curettage by reducing the size of chalazion and improving lid margin abnormalities and meibum grade.

Global improvement in meibomian glands after chalazion surgery demonstrated by meibography

PURPOSE

To evaluate the use of meibography as an objective measure of the effects of incision & curettage (I&C) chalazion surgery on meibomian gland loss and morphology as well as dry eye syndrome.

METHODS

This prospective, interventional clinical study included adult patients with a primary chalazion which persisted despite conservative treatment. All patients underwent I&C surgery. The following parameters were compared both preoperatively and 21 days postoperatively: meibography, tear breakup time (TBUT), Schirmer test, meibum expression, tear meniscus height, meibomian gland dysfunction (MGD) grading, and the Ocular Surface Disease Index (OSDI).

RESULTS

Thirty eyelids were enrolled in the study. The mean age ± SD was 40.56 ± 13.94 years. Meibography demonstrated a significant decrease in meibomian gland loss (P = 0.00) and improvement in morphology. The most common meibomian gland pathology preoperatively noted was morphological signs of atrophy that included fluffy areas and tortuous glands. Both of these findings improved postoperatively (P = 0.04 and P = 0.02, respectively). There were a significant change in MGD grading and a significant decrease in meibum expression score postoperatively (P = 0.00). TBUT and tear meniscus height also improved significantly (P = 0.00 and P = 0.003, respectively). The OSDI score improved significantly as well (P = 0.00).

CONCLUSION

While incision and drainage surgery is a time-honored, standard treatment for chalazion, meibography now demonstrates a global improvement in the meibomian glands, not just the ones involved with the chalazion. In addition to the improvements in the clinical and dry eye syndrome parameters improvements, meibography findings demonstrate that early I&C surgery restores the meibomian glands architecture significantly.

Efficacy of Care and Antibiotic Use for Chalazia and Hordeola

OBJECTIVES

To evaluate whether use of an antibiotic improves the efficacy of care for a chalazion or hordeolum.

METHODS

A cross-sectional retrospective review was performed. All patients treated for a newly diagnosed chalazion or hordeolum at the University of California, San Francisco from 2012 to 2018 were identified. Patients were excluded when clinical notes were inaccessible or there was inadequate documentation of treatment modality or outcome. Patient demographics, setting of initial presentation, treatment modalities, antibiotic use, and outcomes were analyzed.

RESULTS

A total of 2,712 patients met inclusion criteria. Management with an antibiotic was observed in 36.5% of patients. An antibiotic was 1.53 times (95% confidence interval [CI], 1.06-2.22, P=0.025) more likely to be prescribed in emergency or acute care setting for a chalazion. Older age was associated with a higher risk of receiving an antibiotic for a hordeolum (adjusted RR 1.07 per decade, 95% CI, 1.05-1.11, P<0.001). The addition of an antibiotic to conservative measures for a chalazion (adjusted RR, 0.97, 95% CI, 0.89-1.04, P=0.393) or hordeolum (adjusted RR, 0.99, 95% CI, 0.96-1.02, P=0.489) was not associated with an increased likelihood of treatment success.

CONCLUSION

Although frequently prescribed, an antibiotic is unlikely to improve the resolution of a chalazion or hordeolum.

Efficacy of Intense Pulsed Light in the Treatment of Recurrent Chalaziosis

Purpose

High recurrence rate of chalaziosis and serious side effects of repeated surgical excision may help increase awareness of recurrent and refractory chalaziosis as a serious disorder affecting many aspects of life. This present study was aimed to investigate the efficacy and safety of intense pulse light (IPL) therapy and meibomian gland expression (MGX) in cases of recurrent chalaziosis after excision surgery.

Methods

Forty-two consecutive recurrent chalaziosis cases (35 patients) treated with IPL-MGX were enrolled. All patients initially underwent excision with curettage. One week after lesion excision, IPL-MGX were performed at least 3 times. Another set of age- and sex-matched consecutive cases of recurrent chalaziosis, who received excision with curettage, but went without IPL-MGX treatment, were collected to calculate recurrence rate. Treatment efficacy and safety were measured before IPL-MGX treatment and 1 month after the final treatment.

Results

The majority of patients received 4 sessions of IPL-MGX therapy (20 patients; 57.1%) or 3 sessions of IPL-MGX therapy (10 patients; 28.6%), resulting in a lower recurrence rate of 11.4% compared to that of recurrent chalaziosis without IPL-MGX cases (45.6%, P < 0.001). The NIBUT was significantly prolonged from 3.9 ± 1.8 to 5.1 ± 1.7 s at 4 weeks after the final treatment (P = 0.001). Similarly, mean TMH score improved and was statistically significant when compared with baseline (0.17 ± 0.07 vs. 0.21± 0.09; P = 0.008). Furthermore, meibum quality and expressibility scores significantly improved at 4 weeks following the final treatment (both P < 0.001). Other variables, such as intraocular pressure and visual acuity, remained unaffected following treatment.

Conclusion

The combination of IPL treatment and MGX offers a low risk and effective option in decreasing the recurrence rate of recurrent chalaziosis by improving meibomian gland function. IPL-MGX may be considered for first-line treatment in recurrent or refractory cases post excision.

A randomized clinical trial of triamcinolone acetonide injection for suppression of inflammation after blepharoptosis surgery

This study aimed to determine the effectiveness of triamcinolone acetonide in suppressing inflammation after blepharoptosis surgery. The study was designed as prospective, randomized, two medical centers' clinical trial. Thirty-two patients with involutional blepharoptosis of the same degree in both eyelids underwent bilateral transcutaneous levator advancement. At the end of the surgery, 4 mg/0.1 ml of triamcinolone acetonide was injected into a randomly selected upper eyelid. The fellow eyelid was not injected and was used as control. Facial photographs were taken on day 1, week 1, month 1, and month 3, and the degree of inflammation, the margin reflex distance 1 (MRD-1), and levator function (LF) between the two eyelids of each patient were compared. The primary outcome was the selection of the less inflamed eyelid decided by the majority of three individuals unrelated to the study. MRD-1 and LF were analyzed for secondary outcomes. As a result, the injected eyelid was judged to be the less inflamed eyelid in all cases. The MRD-1 in the postoperative period less than 1 month was significantly larger in the injected eyelids than the control eyelids (P<0.03). The postsurgical MRD-1 at month 3, the postsurgical LF at all postsurgical examination times were not statistically different. Adverse complications by the injection, including ptosis, levator dysfunction, increase of the intraocular pressure, and visual disturbance were not observed. In conclusion, a triamcinolone acetonide injection after ptosis surgery is both safe and effective in reducing the early postsurgical inflammation and helpful in an earlier return to a daily routine for the patients.

[Hordeolum and chalazion : (Differential) diagnosis and treatment]

Hordeolum and chalazion are the most frequent inflammatory eyelid tumors. They can occur in association with underlying diseases causing Meibomian gland dysfunction and/or chronic blepharitis. Due to the typical morphological features and clinical course, the diagnosis can mostly be clinically established. The majority of these lesions resolve spontaneously over time. In some instances, surgical intervention is unavoidable. In persistent, recurrent or clinically atypical cases malignant tumors must be excluded as a differential diagnosis by excisional biopsy and histopathological assessment.

Serum Levels of Thyroid Hormone, Vitamin B12, Vitamin D3, Folic Acid, and Ferritin in Chalazion

PURPOSE

To compare serum thyroid hormone, vitamin B12, vitamin D3, folic acid, and ferritin levels between chalazion patients and control.

METHODS

18-65-year-old chalazion patients and controls were included. The peripheric blood sampling results were investigated. Free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), vitamin B12, vitamin D3, folic acid, and ferritin levels of chalazion and control groups were compared.

RESULTS

The male-to-female ratio was 41/107 in chalazion group and 52/106 in control group (p > .05).The mean age was 37.123 ± 13.252 years (18-65) and 39.912 ± 13.747 years (18-65) in the groups, respectively (p > .05).The mean value of vitamin B12 was 304.894 ± 131.592 pg/mL (122.700-985.300) in chalazion group and 353.200 ± 184.341 pg/mL (134.800-1127.000) in control group (p = .038).The mean values of FT3, FT4, TSH, vitamin D3, folic acid, and ferritin levels were similar between the groups (p > .05 for all).

CONCLUSION

This study reports that chalazion patients have less serum vitamin B12 level than healthy subjects.

Local delivery of corticosteroids in clinical ophthalmology: A review

Locally administered steroids have a long history in ophthalmology for the treatment of inflammatory conditions. Anterior segment conditions tend to be treated with topical steroids whilst posterior segment conditions generally require periocular, intravitreal or systemic administration for penetration. Over recent decades, the clinical applications of periocular steroid delivery have expanded to a wide range of conditions including macular oedema from retino-vascular conditions. Formulations have been developed with the aim to provide practical, targeted, longer-term and more efficacious therapy whilst minimizing side effects. Herein, we provide a comprehensive overview of the types of periocular steroid delivery, their clinical applications in ophthalmology and their side effects.

Low level light therapy for the treatment of recalcitrant chalazia: a sample case summary

Purpose

To evaluate the effects of low-level light therapy (LLLT) on the resolution of recalcitrant chalazia.

Patients and Methods

This was a single-site retrospective chart review of patients with chalazia, all of whom were unresponsive to previous pharmaceutical therapy or surgical intervention, who received a 15 min LLLT treatment in conjunction with a standard pharmaceutical regimen. A second treatment was applied 24 hrs to as late as 2 months if there was no evidence of progression of resolution in appearance.

Results

A total of 26 eyes of 22 patients with relevant history and treatment were reviewed, all with a history of prior pharmaceutical treatment for their chalazia. After a single 15 min LLLT treatment, followed by a standard pharmaceutical regimen, 46% of eyes (12/26) showed resolution of their chalazia. Resolution was noted from 3 days to one-month post-treatment. With a second treatment, the chalazia resolved in 92% of eyes (24/26). Only two eyes of the 26 (8%) required incision and curettage after LLLT treatment.

Conclusion

The use of LLLT for the treatment of recalcitrant chalazia appears to be beneficial in patients who have failed topical and/or systemic therapy, significantly reducing the likelihood of requiring surgical intervention.

A prospective randomized study comparing incision and curettage with injection of triamcinolone acetonide for chronic chalazia

PURPOSE

To compare outcomes of intralesional triamcinolone acetonide (TA) injection and incision and curettage (I&C) in the treatment of chronic chalazion.

METHODS

Patients with chronic chalazion were randomized in two groups. The patients in the TA received an intralesional injection of TA and patients in the I&C underwent I&C. The patients were followed up 3, 7, 14, 21, 28, and 45 days after the procedures. We defined success as 90% regression in the size of the lesion.

RESULTS

There were 26 patients in the TA and 25 patients in the I&C enrolled in this study. Complete resolution was achieved in 16 patients (61.5%) in the TA group and 21 patients (84%) in the I&C (P = 0.072). Sex, initial size, and chalazion location did not influence treatment success in either group (P > 0.05). Lesion recurrence occurred in 9 patients (34.61%) in the TA group and 2 (8%) in the I&C (P = 0.04). The average times to resolution were 8.8 ± 5.6 and 5.1 ± 4.5 days in the first and second groups, respectively (P = 0.03). Drug deposition occurred in 24 (92.3%) patients in the TA group, and ecchymosis occurred in 14 (56%) patients in the I&C (P = 0.004) group. Intraocular pressure (IOP) in the TA group and visual acuity (VA) in both groups remained unchanged.

CONCLUSIONS

Both TA injection and I&C modalities are effective in the treatment of chronic chalazia. Advantages of I&C in comparison to TA include less recurrence, shorter duration of complications, and a higher success rate.

Conservative therapy for chalazia: is it really effective?

PURPOSE

To assess the within-treatment efficacy of hot compresses (HC), HC plus tobramycin (Tobrex) and HC plus tobramycin/dexamethasone (Tobradex) for chalazia treatment.

METHODS

Design: Multicentre, randomized clinical trial (ClinicalTrials.gov identifier, NCT01230593).

SETTING

Two clinical sites in New York and two clinical sites in Ontario.

STUDY POPULATION

A total of 149 patients with one or more chalazia on separate eyelids randomly assigned to receive HC (n = 50), HC plus tobramycin (n = 50) or HC plus tobramycin/dexamethasone (n = 49).

INTERVENTION

4-6 weeks of assigned treatment. Patients were measured for chalazion horizontal width and surveyed for pain and treatment satisfaction levels.

MAIN OUTCOME MEASURES

Primary outcome was complete resolution (100% size reduction). Secondary outcomes were size change in millimetres and patient reported pre- and post-treatment pain and satisfaction levels.

RESULTS

In the intention-to-treat (ITT) population, complete resolution occurred in 36 (18%) lesions total, 13 (21%) treated with HC, 12 (16%) with HC plus tobramycin and 11 (18%) with HC plus tobramycin/dexamethasone, with no significant difference between them (p = .78). Individually by paired t-test, there were statistically significant post-treatment mean size differences: HC 1.20 mm (p < 0.001), HC plus tobramycin 1.69 mm (p < .001) and HC plus tobramycin/dexamethasone 1.54 mm (p < 0.001), but no significant difference between them (p = .61). Lesions that completely resolved had a statistically significant lower pretreatment duration (1.5 months) compared to lesions that did not completely resolve (2.2 months) (p = .04).

CONCLUSION

Hot compresses (HC) alone or in combination with tobramycin or tobramycin/dexamethasone drops and ointment are all effective first-line treatment options for chalazia. However, physicians may consider moving directly to the use of more invasive therapies, such as incision and curettage or steroid injections, for chalazia that have been present for more than 2 months, as older lesions are less likely to resolve with conservative therapies alone.

The effects of chalazion surgery on intraocular pressure and corneal topography

PURPOSE

To evaluate the effects of chalazion surgery on intraocular pressure (IOP) and the biomechanical, topographic, and topometric properties of the cornea.

METHODS

A total of 29 patients with upper eyelid chalazion were included in this study. All patients underwent preoperative and postoperative detailed ophthalmological examinations including scale of chalazion size; IOP (IOPcc and IOPg), corneal hysteresis, and corneal resistance factor measurements using ocular response analyser (ORA; Reichert Instruments, Depew, NY, USA); topographic and topometric properties of the cornea using Pentacam HR (Oculus GmbH, Wetzlar, HE, Germany). Preoperative and postoperative measurements were compared.

RESULTS

The mean age of the patients was 29.07 ± 13.74 years (18-54 years). The mean IOPcc was 15.82 ± 4.20 mmHg preoperatively and 14.72 ± 3.96 mmHg postoperatively, and the mean IOPg was 15.21 ± 3.91 mmHg preoperatively and 14.21 ± 4.02 mmHg postoperatively (p = 0.020, p = 0.007, respectively). The mean central keratoconus index (CKI) was 1.006 ± 0.01 preoperatively and 1.002 ± 0.01 postoperatively (p = 0.035). Other biomechanical, keratometric, topographic, and topometric parameters were similar before and after the surgery (all p > 0.05).

CONCLUSION

To the best of our knowledge, this is the first report to suggest that IOP and CKI are decreased after the removal of upper eyelid chalazion.

Incision and Curettage Versus Steroid Injection for the Treatment of Chalazia: A Meta-Analysis

PURPOSE

To compare the efficacy of the chalazia treatment modalities of incision and curettage (I&C) and intralesional steroid injections (SI).

METHODS

Full publications of randomized controlled trials that compared I&C with SI were identified. Aggregated success rate, weighted summary proportions, and weighted pooled relative risk for success were calculated for each method.

RESULTS

Data were extracted from 8 publications that met these criteria, between 1984 and 2013. There were 288 patients treated by SI with aggregate success rate of 60.4% with 1 injection and 72.5% with 1 or 2 injections. The range of the success rate was 8.7 to 86.7% for 1 injection. The success rate for the second SI was 19.0%, with a range of 0% to 53.8%. There were 264 patients treated by I&C with a larger aggregate success rate of 78.0% with 1 procedure and 86.7% with 1 or 2 procedures (p < 0.05 for both comparisons). The range of the success rates was 60.0% to 92.0% for 1 I&C. The success rate for the second I&C was 90.65%, with a range of 83.3% to 100%. Compared with I&C, the overall relative risk for SI with 1 procedure was 0.77 (p = 0.05), while the overall relative risk for 1 or 2 procedures was 0.89 (p = 0.002).

CONCLUSIONS

This analysis shows that I&C is more effective than SI with 1 procedure. This benefit is reduced when comparing 1 or 2 attempts of I&C and SI. Studies failed to show a difference in the incidence of complications with either procedure.

Large anterior orbital cyst as a late complication of chalazion surgical drainage

PURPOSE

To present four patients who developed large cystic lesions attached to the tarsal plate at the site of previously drained chalazion.

METHODS

Medical records for all patients who developed cystic lesion as a complication of chalazion surgery were retrospectively reviewed for clinical and radiological findings, treatment provided, histopathological findings, and complications.

RESULTS

Four patients (one male and three females) with a mean age of 22 years (range, 11-36 years) were enrolled in the study. A history of chalazion surgery was present in all patients at the same site of the cyst attachment to the tarsal plate. The mean interval between the presentation with the cystic lesion and the chalazion surgery was 13 weeks (range, 6-24 weeks). All patients were treated with surgical excision of the cysts, along with local triamcinolone injection. Histopathological findings of the excised cysts were consistent with chalazion. There was no evidence of recurrence or other complication observed during the follow-up visits (the minimum follow-up duration was 6 months).

CONCLUSIONS

Anterior orbital cystic formation (prolapsed chalazion) may occur as a late complication of chalazion surgery. Surgical excision along with steroid injection was effective to manage this rare complication among our patients.

A comparison of intralesional triamcinolone acetonide injection for primary chalazion in children and adults

Purpose. To investigate outcome differences of intralesional triamcinolone acetonide (TA) injection for primary chalazia in children versus adults. Methods. A retrospective review of consecutive subjects with primary chalazion who received intralesional TA injection was conducted. A single investigator injected 0.05–0.15 mL of TA (40 mg/mL) intralesionally. Patients were stratified into the pediatric (<18 years old) and adult (≥18 years old) group. In both groups, the correlation of resolution time with chalazion size and TA dose was performed. Results. 17 children and 24 adults were enrolled, with a mean age of 7.4 ± 5.5 and 39.3 ± 16.7 years, respectively. Both groups had statistically similar baseline characteristics. There was no significant difference between the resolution time in the pediatric (18.2 ± 11.4 days) and adult (16.5 ± 11.0 days) group (P = 0.7). There were no significant complications from the TA injection. There was no significant correlation of resolution time to chalazion size (P = 0.7) nor TA dose (P = 0.3) in both groups. Conclusion. TA for the treatment of primary chalazion was equally effective in children and adults, without any significant complications, and the rate of clinical response did not appear to be dose-dependent.

Time-dependent degenerative transformations in the lipidome of chalazia

The aim of this prospective study was to conduct histopathologic and lipidomic analyses of chalazia, in order to evaluate time-dependent changes in the lesion. Samples of surgically excised chalazia were collected over a period of 12 months from 10 patients (mean age 41 years; range, 23-58) with clinically diagnosed chalazia, who underwent scheduled surgery. The ages of chalazia varied from 2 to 28 weeks. To confirm the clinical diagnoses, the morphology of collected tissue samples was evaluated histologically after hematoxylin and eosin staining. The lipids from individual chalazia were analyzed by high-performance liquid chromatography-mass spectrometry and compared with authentic lipid standards and with the lipids of meibum collected from normal controls. We observed gradual, lesion age-dependent transformation of the lipidome of chalazia from an almost normal meibum-like composition to a very different kind of lipidome. A rapid initial increase in the free cholesterol content was followed by a gradual replacement of extremely long chain meibomian-type lipids with a mixture of shorter-chain cholesteryl esters of the C14-C18 family, triacylglycerols, ceramides, phospholipids and sphingomyelins. In addition, a rapid disappearance of wax esters and cholesteryl esters of (1-O)-acyl-omega-hydroxy fatty acids from the lipidome of aging chalazia was observed. Our results are indicative of dramatic, time-dependent changes in the lesion that may involve cholesterol as a trigger and/or a marker of subsequent degeneration of the meibomian lipidome. We hypothesize that early inhibition of these transformations may be useful in reversing the course of the disease.

Intralesional triamcinolone acetonide injection for the treatment of primary chalazions

The aim of this study was to investigate the safety and efficacy of intralesional triamcinolone acetonide (TA) injection in the treatment of primary chalazions not responding to conservative treatment. Patient medical records were retrospectively reviewed for all consecutive patients that received intralesional TA injection by a single surgeon between January 2012 and March 2013 for the treatment of unresolved primary chalazions despite 1 month of conservative treatment. The dose of TA injection ranged from 2 to 6 mg (40 mg/mL) depending on the size of the chalazion. The main outcome measures included time to resolution, time to 50 % size reduction, and complications from the treatment. During the study period, 48 chalazions from 38 patients were treated by intralesional TA injection. A 50 % reduction in size was achieved in 81.3 % of chalazions in 4 weeks and 83 % achieved complete resolution in 6 weeks. The mean time to complete resolution was 15.7 ± 10.0 days. There were no complications noted from the injections; 14.6 % required subsequent incision and curettage and 2.1 % required a second TA injection for complete resolution. Intralesional TA injection is a safe, simple, and effective procedure for the management of primary chalazions and may be considered as an alternative to incision and curettage in cases not responding to conservative treatment.

Treatment of Multiple Chalazions with Intralesional Kenalog-40 Injections in Juvenile Patient: A Case Report

Aim: To case report the efficacy of subcutaneous steroid injections in the treatment of multiple chalazions and to evaluate the safety of intralesional injection in primary and recurrent chalazions in juvenile patient.Case report: A 25-year-old man noticed lesions which appeared on upper lid during past three months. It was clinically presented with three focal, large and painful nodules in upper right eyelid. Inflammation process began on May the 1st of 2013. After one month in May 30th 2013 was directly administered synthetic steroid, Kenalog-40. Application of triamcinolone acetonide resulted in two satellite lesions, compared to the original, when the same incisions drained during the first surgery in July 5th 2013, with topical antibiotic-steroidal drugs and hot compresses. Second surgery was in July 26th 2013. Third surgery was performed in August 5st 2013 with second application of Kenalog-40. Combined treatment leads to recovery of clinical signs and inflammation of right upper eyelid with regressions of primary and recurrent chalazions.Conclusion: Two steroid subcutaneous injections produced complete resolution of multiple primary and recurrent chalazions. Clinical imperative was that recurrent or unusual refractory chalazions require referral to Hystopathological examination of curetting to exclude malignancy.