Chalazion Treatment, Surgery, Prevention

Chalazion Treatment
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Chalazion Treatment/Chalazion and sebaceous carcinoma of the eyelid are diseases that originate predominantly from meibomian glands. Chalazion is a relatively common condition characterized by lipogranulomatous inflammation of meibomian glands in the eyelid. It often arises secondarily to noninfectious obstruction of a meibomian gland duct. Histopathologically, chalazion manifests as a lipogranulomatous reaction to liberated lipid granules contained within a connective tissue pseudocapsule. It is usually managed by the application of a hot compress and good eyelid hygiene. Symptomatic chalazion can be removed by incision and curettage. The prognosis for individuals with chalazion is excellent.

Chalazia (plural of chalazion), are the most common inflammatory lesions of the eyelid. They are typically slowly enlarging, non-tender eyelid nodules. A deep chalazion is caused by inflammation of a tarsal meibomian gland. A superficial chalazion is caused by inflammation of a Zeis gland. Chalazia are typically benign and self-limiting, though they can develop chronic complications. Recurrent chalazia should be evaluated for malignancy.

Chalazion Treatment

Causes of Chalazion

  • A chalazion occurs when the opening of an oil-producing gland in the eyelid becomes clogged. Oil-producing glands line the eyelids and help lubricate the surface of the eye. When the opening of the gland becomes blocked, oil backs up inside the gland, causing the eyelid to swell. After the initial redness and swelling go away, a firm lump forms in the eyelid.
  • You have glands throughout your body. They make things that your cells, tissues, and organs need to work properly. The meibomian glands in your upper and lower eyelids make oil that mixes with your tears to moisten and protect your eyes. If the oil gets too thick or if the glands are plugged because of inflammation, you may get a chalazion.

Symptoms of Chalazion

Eyelid affected by a chalazion
  • Painless swelling on the eyelid
  • Eyelid tenderness typically none to mild
  • Increased tearing
  • Heaviness of the eyelid
  • Redness of conjunctiva
  • A small lump on the eyelid
  • Swelling of the eyelid
  • Soreness or discomfort
  • Redness of the skin
  • Watery eye
  • Mild irritation in the eye
  • Blurry vision
  • Painless bump or lump in the upper eyelid or, less frequently, in the lower eyelid
  • Caused by a thickening of the fluid in the oil glands (meibomian glands) of the eyelid
  • Tearing and mild irritation may result as the obstructed glands are needed for healthy tears
  • Blurred vision, if the chalazion is large enough to press against the eyeball
  • More common in adults than children; most frequently occurs in people aged 30-50
  • Disappears without treatment within several weeks to a month, although they often recur

Chalazion Treatment

Diagnosis of Chalazion

A chalazion is best diagnosed by your eye doctor, who can advise you on treatment options. Necessary testing might include:

  • Patient history – to determine symptoms and the presence of any general health problems that may be contributing to the eye problem.
  • External examination of the eye – including lid structure, skin texture and eyelash appearance.
  • Evaluation of the lid margins – base of the eyelashes and oil gland openings using bright light and magnification
  • Photograph of the tarsal conjunctiva of the left upper eyelid. Conjunctival injection and swelling at the nasal and lateral aspects were apparent.
  • Noninvasive meibographic image of the tarsal conjunctiva of the left upper eyelid and
  • Its schematic representation. Meibomian glands in the central area of the eyelid had a normal appearance (arrows), whereas lesions at the nasal and lateral sides showed a lower reflectivity (open arrowheads) but contained small regions of higher reflectivity (closed arrowheads).
  • Photograph of the curettage specimen at the nasal side.
  • Noninvasive meibographic image of the curettage specimen and
  • Its schematic representation. Low reflectivity was apparent for the granuloma lesion (open arrowhead) and high reflectivity for fatty granules (closed arrowheads).
  • Histopathologic analysis of the granuloma lesion.

Treatment of Chalazion

  • The most commonly prescribed oral medicines for blepharitis and meibomian gland dysfunction are antibiotics such as doxycycline.
  • Topical and oral antibiotics usually are ineffective as direct treatments for chalazia, which have no active infectious component that would require this kind of approach.
  • A large chalazion ca. 20 minutes upon excision. This bipartite chalazion was removed via two separate incisions. Further along the lower eyelid, signs of chronic inflammation (Blepharitis) are visible.
  • Topical antibiotic eye drops or ointment (e.g., chloramphenicol or fusidic acid) are sometimes used for the initial acute infection, but are otherwise of little value in treating a chalazion. Chalazia will often disappear without further treatment within a few months, and virtually all will reabsorb within two years.[rx] Healing can be facilitated by applying a warm compress to the affected eye for approximately 15 minutes 4 times per day. This promotes drainage and healing by softening the hardened oil that is occluding the duct.[rx]
  • If they continue to enlarge or fail to settle within a few months, smaller lesions may be injected with a corticosteroid, or larger ones may be surgically removed using local anesthesia.[rx][rx] This is usually done from underneath the eyelid to avoid a scar on the skin. If the chalazion is located directly under the eyelid’s outer tissue, however, an excision from above may be more advisable so as not to inflict any unnecessary damage on the lid itself. Eyelid epidermis usually mends well, without leaving any visible scar.[rx]
  • Perform a diet rich in omega 3 fatty acids, as well as a correct eyewash with special wipes paying attention to the inner part of the eyelids (especially the makeup like mascara or eyeliner that directly affect the exit area these glands) are sufficient to prevent the formation of these lesions in cases without palpebral pre-existing pathology.

Warm compresses

Applying a warm compress to the affected eye can help soften any hardened oil blocking the gland ducts. This helps the ducts open and drain more effectively, which can relieve irritation.

To make and use a warm compress:

  • Soak a soft, clean cloth or cotton pad in a bowl of warm water.
  • Wring out any excess liquid.
  • Apply the damp cloth or pad to the eyelid for 10–15 minutes.
  • Continue wetting the compress often to keep it warm.
  • Repeat this several times a day until the swelling goes down.

Gentle massage

Gently massaging the eyelids for several minutes each day can help the oil ducts drain more effectively. Before doing so, ensure that the hands are clean to reduce the risk of infection. Once the chalazion begins to drain, keep the area clean and avoid touching it with bare hands.

Surgery

Surgical Technique of Subconjunctival Total Excision (Group I)

  • A chalazion clamp was applied after infiltration with 2% lignocaine with adrenaline and the eyelid everted. A No. 15 Bard-Parker blade was used to make an incision perpendicular to the lid margin overlying the highest bulge of the chalazion. The incision stopped at least 4mm short of the lid margin.
  • Fine scissors were slipped under the conjunctiva on both sides of the incision to undermine and separate the underlying granuloma.
  • Undermined conjunctiva was then retracted sideways to expose the bulk of the chalazion. Resection of the chalazion was started at the end farthest from the lid margin. The chalazion was grasped with fine forceps and lifted. Fine scissors were used to undermine a plane between the chalazion and the orbicularis muscle. Dissection was carried out around the chalazion with the last excision being adjacent to the lid margin.
  • It was usually possible to remove the chalazion in one piece, but some had to be removed piecemeal. The process finished with the smooth surface of the orbicularis lining the floor of the wound and the firm white tarsus along the lateral edges. The conjunctiva was brushed back over the wound, the clamp removed and pressure applied to achieve haemostasis. The eye was then lightly patched after instillation of chloramphenicol eye ointment. The patch was removed after 12-24 hours.

Surgical Technique for Incision and Curettage (Group II)

  • Steps upto making the incision were identical to that in Group I. After making the incision the contents of the chalazion were vigorously curetted out. The clamp was removed and haemostasis achieved. After­care was similar to that in group 1.

Technique for Intralesional Injection (Group III)

  • Patients received one injection of triamcinolone acetonide 20 mg/ml, through the conjunctival aspect using a 26G needle. The average volume injected.

Prevention

Also follow these tips

  • Wash your hands thoroughly and often and especially before touching your face and eyes.
  • Wash your hands before and after removing contact lenses. Clean contacts with disinfectant and lens cleaning solution. Discard daily wear or other “limited use” lenses on the schedule recommended by your eye doctor.
  • Wash your face to remove dirt and/or makeup before going to bed.
  • Throw away all old or expired makeup. Replace mascara and eye shadow every 2 to 3 months. Never share or use another person’s makeup.
  • Make sure that anything that comes in contact with your eyes, such as contact lenses and glasses, is clean.
  • If you have a condition that increases your chance of developing chalazia, follow your doctor’s instructions to help control them.
  • Do not push on or squeeze a chalazion.
  • Do not rub or touch your eyelid with unwashed hands.
  • Do not wear makeup or contact lenses until the area has fully healed.
  • In-office incision (under local anesthesia) to drain the chalazion
  • Steroid injection to reduce the swelling

References

Chalazion Treatment

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