Chalazion
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Pathogenesis
A chalazion may be a sterile chronic granulomatous inflammatory lesion (lipogranuloma) of the meibomian, or sometimes Zeis, glands caused by retained sebaceous secretions. Histopathology indicate a lipogranulomatous chronic inflammatory picture with extracellular lipid deposits surrounded by lipid-laden epithelioid cells, multinucleated giant cells and lymphocytes. Blepharitis is usually present; rosacea are often related to multiple and recurrent chalazia. A recurrent chalazion should be biopsied to exclude malignancy.
Diagnosis
• Symptoms
○ Subacute/chronic: gradually enlarging painless roundednodule.
○ Acute: sterile inflammation or bacterial infection with localized cellulitis . A secondarily infected Meibomian gland is mentioned as an indoor hordeolum.
• Signs
○ A nodule within the tarsal plate, sometimes with associated inflammation.
○ Bulging inspissated secretions could also be visible at the orificeof the involved gland.
○ There could also be an associated conjunctival granuloma.
○ A lesion at the anterior lid margin – a marginal chalazion – could also be connected to a typical chalazion deeper within the lid or flow from to isolated involvement of a gland of Zeis.
Treatment
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• Oral antibiotics for significant bacterial infection.
• Conservative. a minimum of a 3rd of chalazia resolve spontaneously so observation could also be appropriate, especially if the lesion is showing signs of improvement, though early definitive treatment has been reported to steer to higher patient satisfaction.
• Hot compress application several times daily may aid resolution, particularly in early lesions.
• Expression. Compression between two cotton-tipped applicators is usually effective in expressing the contents of a fresh lesion near the lid margin.
• Steroid injection into or round the lesion has been reported to offer similar resolution rates to incision and curettage (see below). it's going to be preferred for marginal lesions or lesions on the brink of structures like the lacrimal punctum due to the danger of surgical damage.
○ Reported regimens include 0.2–2 ml of triamcinolone acetonide aqueous suspension diluted with lidocaine to a degree of 5 mg/ml, and 0.1–0.2 ml of 40 mg/ml, injected with a 27- or 30-gauge needle.
○ The success rate following one injection is about 80%; a second are often given 1–2 weeks later.
○ Local skin depigmentation and fat atrophy are potential but uncommon complications, the danger of which can be reduced by avoidance of infiltration immediately subcutaneously or by utilizing a conjunctival approach.
○ Retinal vascular occlusion has been described as a complication, probably thanks to intravascular injection with subsequent embolization.
• Surgery
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○ Following local anesthesia infiltration, the eyelid is everted with a specialized clamp , the cyst is incised vertically through the tarsal plate and its contents curetted.
○ Limited excision of solid inflammatory material with fine scissors could also be helpful in some cases, especially if there's no focus of secretions.
○ A suture shouldn't be used.
○ Topical antibiotic ointment is employed 3 times daily for 5–7 days following curettage.
• Marginal lesions are often managed by steroid injection, by curettage of an associated deeper chalazion, by shave curettage or by incision and curettage via a horizontal incision on the conjunctival surface or vertically through the grey line.
• Prophylaxis
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○ Treatment of blepharitis, e.g. daily lid hygiene regimen.
○ Systemic tetracycline could also be required as prophylaxis in patients with recurrent chalazia, particularly if related to rosacea .
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