Therapeutic effect of intense pulsed light on different types of chalazion in children.

This study aims to investigate the effectiveness of Intense Pulsed Light (IPL) therapy for chalazion treatment while also exploring potential variations in sensitivity among different types of chalazion. A total of 149 patients were selected to receive tobramycin combined with IPL treatment and tobramycin combined with hot compress. The treatment groups were divided into cystic type and granulomatous type according to different clinical manifestations. The course of treatment was 3 weeks. The improvement was based on the ultrasound measurement of the masses reduction of more than 50% or disappearance. In the IPL group, 17 (22.67%) cases were cured, 39 (52.00%) were effective, and 19 (25.33%) were ineffective. This includes: cystic type was cured in 3 (15.79%), effective in 5 (26.32%) cases, ineffective in 11 (57.89%) cases; granulomatous type was cured in 14 (25.00%) cases, effective in 34 (60.71%) cases, ineffective in 8 (14.29%) cases. In the hot compress group, 5 (6.76%) cases were cured, 16 (21.62%) cases were effective and 53 (71.62%) cases were ineffective. The cystic type was cured in 2 (8.00%) cases, effective in 3 (12.00%) cases and ineffective in 20 (80.00%) cases; the granulomatous type was cured in 3 (6.12%) cases, effective in 13 (26.53%) cases and ineffective in 33 (67.35%) cases. The cure rate and efficacy rate of IPL treatment is higher than that of hot compress treatment, the treatment effect of IPL treatment on granulomatous chalazion is better than that on cystic type.

Novel treatment of chalazion using light-guided-tip intense pulsed light.

We assessed the effectiveness of light-guided-tip intense pulsed light (IPL) with meibomian gland expression (MGX) in chalazion treatment. Ninety-five eyes with chalazion received a light-guided-tip IPL-MGX treatment (IPL-MGX group), and another 95 eyes with chalazion received incision with curettage treatment (Control group). Prior to IPL or incision, as well as 1 month after the final treatment, data were gathered pertaining to the lesion location and size, hyperemia, lesions regression or recurrence, and a comprehensive ophthalmic examination. The total size of the chalazia in the IPL-MGX group was significantly reduced after the final treatment, with an average resolution rate of 70.5%, which is comparable to excision surgery. A significant decrease in chalazion recurrence rate was apparent after treatment in the IPL-MGX group compared with control. Moreover, the IPL-MGX demonstrated significant advancements throughout noninvasive tear film breakup time (NIBUT) as well as meibum grade in comparison to baseline and those in the the Control group. The use of IPL-MGX was found to be an efficient therapy for reducing the size and recurring frequency of chalazia, as well as for improving the meibomian gland function. It may be considered as a first-line treatment for cases of primary or recurrent chalazia with inflammation.

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.

Intense pulsed light combined with meibomian gland expression for chalazion management.

OBJECTIVE: To investigate the efficacy and safety of an intense pulsed light (IPL) combined IPL treatment protocol for meibomian gland dysfunction (MGD)/dry eye disease (DED) with IPL applied directly to the eyelids, associated with meibomian gland (MG) expression for the treatment of chalazion. MATERIAL AND METHODS: Retrospective case series study. Patients presenting with chalazion received a combined IPL therapy treatment consisting of using the usual IPL protocol for DGM/EOS using a fluence according to skin type according to Fitzpatrick, followed by a second phase (in the same session) of IPL application directly on the eyelids of both eyes using a fluence of 10J/cm2. All patients then received GM expression, eyelid hygiene, topical antibiotic and topical ocular anti-inflammatory medication. Adverse effects related to this protocol were assessed at each IPL session. RESULTS: Twenty-six chalazions from nineteen patients (24 eyes) with a mean age of 49.89±20.43 years were included. An average of 2.07±0.97 IPL sessions were required for chalazion resolution. The combined treatment of IPL protocol and GM expression showed 96.15% efficacy and no adverse effects were observed. CONCLUSIONS: Combined IPL treatment for MGD/DED with IPL applied directly onto the eyelids and MGX could be effective and safe for the management of chalazions.

Parent-provided photographs as an outcome measure for childhood chalazia.

PURPOSE: To determine whether smartphone photographs of children's eyelids are reliable for diagnosing the presence of chalazia. METHODS: In this prospective cross-sectional study, 60 participants, 7 months to 16.5 years of age, at four sites were enrolled; all participants had a chalazion measuring at least 2 mm on at least one eyelid based on an in-person clinical examination by a pediatric eye care professional. Smartphone photographs taken by the parent during the office visit were uploaded to the study website. A masked reader assessed each photograph for the presence or absence of chalazia; results were compared with the gold standard clinical examination results. Sensitivity and specificity for the presence of chalazion by eyelid were calculated. RESULTS: Photographs were available for 240 eyelids; 85 had at least one chalazion and 155 were without a chalazion based on clinical examination. The masked reader correctly classified 68 of 85 eyelids with at least one chalazion and 151 of 155 eyelids without chalazia for a sensitivity of 80% (95% CI, 72%-86%) and a specificity of 97% (95% CI, 94%-99%). Sensitivity improved to 89% for chalazia 5 mm or larger and 94% when superficially located within the eyelid. CONCLUSIONS: Parental smartphone photographs appear to be useful in assessing chalazia in children as an alternative to in-office follow-up examinations. These photographs may be a valuable outcome measure in future clinical trials of chalazia treatment, especially when assessing larger lesions.

Common inflammatory and infectious conditions of the eyelid.

Patients with infection or inflammation of the eyelid will often first present to their primary care physicians with symptoms such as redness, swelling, tearing, itchiness, or a foreign body sensation. There are a variety of conditions that affect the eyelid which can cause such symptoms, and the exam and history can help a provider differentiate some of the more common conditions. This article will provide a comprehensive review of the background, diagnosis and management of dry eye disease, chalazion, hordeolum (stye), and preseptal cellulitis.

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.

Intralesional Triamcinolone Acetonide (TA) Versus Incision and Curettage (I & C) for Medium and Large Size Chalazia.

INTRODUCTION: Chalazion is a common inflammatory mass lesion of eyelid. Incision and curettage is a conventional treatment but intralesional steroid is also a safe option for multiple chalazia and chalazion near lacrimal drainage system. So, we conducted an interventional study to compare the treatment outcomes of injection triamcinolone acetonide (TA) versus incision and curettage (I&C) in medium and large sized primary chalazion. OBJECTIVE: To compare the success rate of intralesional TA versus I&C for the treatment of medium and large sized primary chalazia. MATERIALS AND METHODS: An interventional study was carried out in 118 patients with primary chalazion. The patients were divided equally into two groups A and B of medium sized (3-7mm) and large sized chalazia (>7mm) respectively. Treatment modality either I&C or TA was decided in each group by randomization Cytological evaluation was done for each case and diagnosis other than chalazion was excluded. Main outcome measure was resolution in size more than 80%. Secondary outcome measure was correlation of cytological features with size, duration, success rate and complications. CONCLUSION: Intralesional TA was found to be as effective as I&C in both the groups. In cytological analysis, we found that in large sized chalazia I&C is superior to TA in suppurating granuloma.

Aplicaciones de la toxina botulínica en afecciones palpebrales / Uses of botulinum toxin in eyelid diseases

La toxina botulínica es un potente inhibidor neuromuscular altamente específico que produce una denervación química al bloquear la liberación de acetilcolina en la placa motora. Es sintetizada por Clostridium botulinum. Es un fármaco de alto valor terapéutico en las alteraciones de los anexos oculares; puede indicarse con muy buenos resultados en afecciones como el blefarospasmo primario, el espasmo hemifacial, el chalazión, el entropion espasmódico, la retracción palpebral, la ptosis de la ceja, la mioquimia palpebral y en el tratamiento de líneas de expresión facial, con muy buenos resultados estéticos. Se realizó una búsqueda bibliográfica y en Internet utilizando distintas bases de datos como Medline, Google, Bireme, PubMed.gov, así como artículos relevantes de la Academia americana de Oftalmología y Neurología con el objetivo de describir las aplicaciones de la neurotóxica botulínica en las afecciones de los anexos oculares(AU)

Botulinum toxin is a highly specific potent neuromuscular inhibitor that produces a chemical denervation when blocking the release of acetylcholine in the motor plaque. It is synthesized by clostridium botulinum. It is a drug with high therapeutic value to treat ocular adnexas and may be indicated for primary blepharospasm, hemifacial spasm, chalazion, spasmodic entropion, palpebral retraction, eye brow ptosis, palpebral myokymia and in treating expression lines of the face, all with very good esthetic results. Literature search was made in Internet by using databases such as Medline, Google, Bireme, PubMed.gov, as well as outstanding articles of the American Academy of Ophthalmology and Neurology with the objective of describing the uses of botulinum toxin for ocular adnexa diseases(AU)

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.

Carcinoma de glándulas sebáceas palpebrales / Carcinoma of palpebral sebaceous glands

El carcinoma de glándulas sebáceas es un tumor altamente maligno y potencialmente letal. Puede enmascarar enfermedades inflamatorias como blefaritis, blefaroconjuntivitis, meibomitis, tarsitis y chalazión recurrente. Por eso, ante la presencia de una lesión palpebral de presentación atípica o recidivante se impone una exéresis completa con margen oncológico para su estudio anatomopatológico. Esta afección cursa con un diagnóstico clínico difícil, y en ocasiones inadvertido, por lo que se realizó una revisión bibliográfica para profundizar en sus diferentes formas de presentación, pronóstico y tratamiento(AU9

The sebaceous gland carcinoma is a highly malignant tumor and potentially lethal; it may masquerade inflammatory diseases such as blepharitis, blepharoconjunctivitis, meibomitis, tarsitis and recurrent chalazion. Hence, the presence of palpebral injury of recurrent or atypical presentation imposes a complete resection with oncological margin for pathological examination. This condition presents with difficult clinical diagnosis and sometimes unnoticed, so we conducted a literature review to delve into its various forms of presentation, prognosis and treatment(AU)

Chalazion management--surgical treatment versus triamcinolon application.

The aim of the study was to compare the length of treatment and efficiency of applied therapy in two groups of patients with chalazion who underwent surgical procedure or got triamcinolone application in chalazion. Our study included 30 patients with chalazions that persisted for about one month. All of them were resistant to applied topical antimicrobial therapy. These patients were devided in two groups. 15 patients underwent surgical procedure that included incision, excochleation and excision of the capsule of chalazion, while other 15 patients underwent triamcinolone aplication directly in chalazion (dosage of 2-4 mg). Patients were followed up a day after therapy, two weeks after therapy and one month after applied therapy. We found that chalazion treatment with triamcinolone application directly in the lesion was to be more comfortable for patients, took less time to treat and needed no additional topical antimicrobial therapy.

Ocular inflammation and infection.

Ocular inflammation and infection may involve any part of the eye and surrounding tissue. A complete examination, including visual acuity, extraocular movements, pupillary response, slit lamp examination, and fluorescein staining, is often required to establish the diagnosis. Pain relief may be achieved with oral analgesics and cycloplegics. In most cases, prompt follow-up is required.