Chalazion Treatment

Chalazion is a chronic lipogranulomatous inflammation of the meibomian or Zeis glands, caused by cystic retention of material in the sebaceous glands. It is one of the commonest eyelid disorders of all age groups, and usually, presents with inflammation and irritation of the eyelid and ocular surface. Although it may be a self-limited disease, its management can be difficult for both the ophthalmologists and the patients, due to its high recurrence rate and chronicity. The treatment modalities include eyelid hygiene with hot compresses, topical antibiotic ointment, and systemic tetracycline in cases with acne rosacea. However, most lesions usually necessitate more invasive procedures like steroid injections or incision and curettage surgery.

Localized steroid injections are given in the form of Kenakort-A (triamci-nolone acetonide 0.1–0.2 ml of 40 mg/ml) suspension. The injection is performed directly into the lesion via a conjunctival approach. Antibiotic ointment is applied and the eye is not patched after the injection.

The classical therapeutic approach in, chalazion is the incision and curettage surgery. I prefer to use a scalpel blade for incision and curettage of chalazion. In this technique, local anesthetic (2% lidocaine with 1:100,000 epinephrine) is infiltrated around the chalazion. A chalazion clamp is placed over the lesion and the eyelid is everted. The clamp is tightened. A scalpel blade is used to make first a vertical incision into the tarsus. Then a horizontal incision is performed to complete a cross shaped incision into the chalazion, A chalazion curette is used to scrape out the contents of the cyst. The fibrous capsule around the chalazion is excised with scissors. The clamp is slowly loosened and any bleeding points are cauterized. Antibiotic ointment is applied and the eye is patched.

Ben Simon et al. (2005) performed intralesional triamcinolone injections in 155 cases. They concluded that this treatment was effective in lesion regression in most cases with 1 or 2 injections. They reported that chalazia which did not respond to 2 or 3 injections were more likely to benefit from incision and curettage surgery. Goawalla and Lee's (2007) prospective randomized study compared the effectiveness of hot compresses, steroid injections and surgical curettage in 136 patients. They reported that steroid injections and incision and drainage surgery had comparable results, and gave better results than conservative treatment with hot compresses.

Although more predictable results are achieved with incision and curettage surgery, there are few shortcomings of this approach. First, some patients dislike the idea of undergoing surgery and prefer injections to surgery. Second, the surgery usually necessitates standard equipments and sterility conditions that make it more expensive than its alternatives. Third, many surgeons prefer patching the eye for 24 hours, which make surgery a less favorable option, especially in younger patients who have concerns with their time loss of working hours, as well as their cosmesis.