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.

Eyelid Fat Atrophy and Depigmentation After an Intralesional Injection of Triamcinolone Acetonide to Treat Chalazion.

Two patients with depigmentation and fat atrophy after an intralesional injection of triamcinolone acetonide (TA) to treat chalazion are reported. A 2-year-old girl with chalazion in her right lower eyelid received a subconjunctival injection of TA and developed fat atrophy and depigmentation around the injected area. These changes subsided after 7 months. The second patient was a 5-year-old boy who received a triamcinolone injection into a chalazion through the eyelid skin and also developed fat atrophy and depigmentation but these changes improved after 1 year.

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.

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.

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 impact of topical treatment for chalazia on the odds of procedural management.

Chalazia in pediatric patients are often treated with topical antibiotics or steroids, although no strong evidence supports their use. This retrospective review of pediatric patients with chalazia did not find a decreased odds of undergoing procedural treatment (incision and curettage and/or intralesional steroid injection) with initial topical antibiotics and/or steroids compared to conservative measures. Inflamed chalazia may benefit from topical treatment, but small sample size limits this subgroup analysis. Shorter pre-topical treatment chalazion duration correlated with a lower risk of procedural intervention. Regimens that included steroids were not found to be more effective than topical antibiotics alone.

Adult Eye Conditions: Common Eye Conditions.

In primary care practices and emergency departments, approximately 2% to 3% of visits are related to eye conditions. The most common diagnoses are corneal abrasion, corneal foreign body, conjunctivitis, external hordeolum (stye), and subconjunctival hemorrhage. This section addresses hordeolum, chalazion, conjunctivitis, corneal abrasion, and corneal foreign body. A thorough history and physical examination are crucial for patients with these conditions, and frequently are sufficient for diagnosis. Conservative therapies are first-line treatments for hordeolum and chalazion, including application of warm compresses, eyelid scrubs, and eyelid massage. Conjunctivitis is the most common etiology of red eye and has infectious and noninfectious causes. Bacterial conjunctivitis typically resolves in 1 to 2 weeks, but can be managed with topical antibiotic solutions or ointments. Viral conjunctivitis management involves frequent handwashing and use of cool compresses and artificial tears. Corneal abrasion is the most common eye injury seen in emergency departments, and corneal foreign body is the second most common. Topical antibiotics and cycloplegics are mainstay therapies for corneal abrasion, with consideration of topical nonsteroidal anti-inflammatory drugs for pain management. Follow-up visits are recommended for select patients. Management of corneal foreign body requires prompt removal of the object, pain management, consideration of prophylactic antibiotics, and follow-up when appropriate.

Safety of topical ophthalmic antibiotics in pregnant women with hordeola, chalazia, blepharitis, or bacterial conjunctivitis: propensity score analyses.

OBJECTIVE: To investigate the association between exposure to topical ophthalmic antibiotics during pregnancy and adverse neonatal outcomes. METHODS: In this retrospective cohort study, we identified pregnant women with hordeola, chalazia, blepharitis, or bacterial conjunctivitis from 2005 to 2018 using the Japanese Medical Data Centre Claims Database. From the eligible women, we extracted women who were dispensed no topical antibiotics during the first trimester (non-antibiotic group), women who were dispensed topical fluoroquinolones alone at least once (fluoroquinolone alone group), and women who were dispensed any single type of antibiotic (single-antibiotic group). We compared the frequency of congenital anomalies (CA), preterm birth (PB), low birth weight (LBW), and the composite outcome of these three between the fluoroquinolone and non-antibiotic groups and between the single-antibiotic and non-antibiotic groups, using propensity score adjustment. RESULTS: A total of 891 eligible women were identified. In the fluoroquinolone (n = 409) and non-antibiotic (n = 309) groups, CA occurred in 6.8% and 6.8%, PB in 2.4% and 3.2%, LBW in 2.9% and 3.2%, and the composite outcome in 10.5% and 11.3%, respectively. Analysis using propensity score adjustment showed no significant difference between the groups in the frequency of CA (adjusted odds ratio, 1.15; 95% confidence interval, 0.61-2.18), PB (0.80; 0.30-2.17), LBW (1.08; 0.45-2.63), or the composite outcome (1.12; 0.67-1.87). Comparison of the single-antibiotic and non-antibiotic groups showed similar results. CONCLUSIONS: Topical ophthalmic antibiotics for hordeola, chalazia, blepharitis, or bacterial conjunctivitis during the first trimester were not associated with increased adverse neonatal outcomes.

Added Advantage Of Injecting Subtarsal Steroid Injection After Incision And Curettage Of Multiple Chalazion.

BACKGROUND: Being one of the most common eye lid inflammatory lesions, there is an abundance of ways its treatment can be approached; however, the dearth of consensus on its management guidelines still remains a point of interest in peer reviewed literature. PURPOSE: To evaluate the additional advantage of injecting subtarsal steroid injection simultaneously with incision and curettage of multiple eye lid chalazion. METHODS: This intervention study was carried out in the Ophthalmology unit of Khalid Eye Clinic, Karachi from February to July 2019 and included fifty patients of both male and female with age ranging between 15-45 years. The patients were distributed into two groups with twenty-five patients in each group. Group A included patients undergoing incision and curettage only for eye lid multiple chalazion, whereas, Group B included patients undergoing incision and curettage with simultaneous subtarsal steroid injection. Post operatively patients were advised to do hot compresses for at least five days and observe the resolution of swelling and recurrence of chalazion for up to six months. RESULTS: The average time for resolution of the swelling in group A patients was 4.4±1.45 days, but eleven out of the twentyfive patients developed chalazion on the same eye lid again within the follow up period. Although group B patients took 6.0±2.7 days for the resolution of swelling but none of them developed recurrent chalazion within the follow up period. CONCLUSIONS: Patients undergoing incision and curettage with simultaneous steroid injection proved to have an additional benefit in terms of reduction in recurrence of chalazion.

The Effect of Oral Vitamin A Supplementation on Chalazion in Young Children with Vitamin A Deficiency: A Pilot Study.

Purpose: Many researchers have reported that vitamin A (VA) deficiency is related to chalazion. The purpose of this article is to clarify the effects of VA supplementation on chalazion in young children with VA deficiency. Methods: Forty-eight young children with VA deficiency suffering from chalazia were enrolled from our previous studies and were followed continuously for 1 year. Serum VA levels and recurrence of chalazion were observed. Results: The mean serum VA levels increased after supplementation (P = 2.17E-15). The mean serum VA levels of subjects who experienced recurrence were lower than those without recurrence (P = 0.015). The recurrence rate and the mean recurrent frequency after supplementation were lower than before supplementation (P = 0.01, P = 6E-6); the mean time to the first recurrence of subjects without recurrence was longer after supplementation than before supplementation (P < 0.01). Conclusions: Oral VA supplementation could reduce the recurrence of chalazion in young children with preexisting VA deficiency.

Bilateral and multifocal central serous chorioretinopathy after injecting triamcinolone into a chalazion. / Coriorretinopatía serosa central bilateral y multifocal después de inyectar triamcinolona en un chalazión.

We present a case of bilateral and multifocal central serous chorioretinopathy that developed one month after an intra-chalazion triamcinolone acetonide injection. Central serous chorioretinopathy spontaneously resolved during observation 3 months after diagnosis. We believe that central serous chorioretinopathy can occur as a complication of administration of depot corticosteroids even at a low dose.

Botulinum toxin A injection for primary and recurrent chalazia.

BACKGROUND: To study the efficacy and safety of subcutaneous botulinum toxin A injections in the treatment of primary and recurrent chalazia. METHODS: Prospective, placebo-controlled consecutive case-series trial. Sixty three patients were divided into two groups: group 1 consisting of 32 patients previously diagnosed with and treated for primary or recurrent chalazia with 2-5 international units (IU) in 0.2-0.5 ml of preserved saline solution of botulinum toxin injection, and group 2 consisting of 31 patients receiving placebo. The main outcome measures were localization and duration of the disease, size of chalazion before and after treatment, clinical resolution of chalazion, time to resolution, and complications of treatment. RESULTS: There was a clinically and statistically significant between-group difference in the rate of therapeutic success and post-therapeutic chalazion regression, but not in the rate of complications. CONCLUSIONS: Botulinum toxin A injection is effective and safe treatment for primary and recurrent chalazia. Lesion regression that did not respond to the average of two injections would benefit more from surgical excision or systemic antibiotic therapy.

Childhood ocular rosacea: considerations for diagnosis and treatment.

Rosacea in children is not as well described as it is in adults. Ocular signs may be a dominant feature and some children with what has previously been called periorificial dermatitis may in fact have rosacea. We report three cases of paediatric ocular rosacea responding to prolonged treatment with oral erythromycin. Our cases demonstrate the close association of periorificial dermatitis with childhood rosacea, and highlight the importance of eye signs in its diagnostic criteria.

Management of chalazia in general practice.

BACKGROUND: Chalazia, or meibomian cysts, are often seen in general practice. While most can be resolved with a minor operation in a designated procedure room, there is a lack of published literature on the details of the incision and curettage used to treat this condition. OBJECTIVE: This article outlines the management and treatment of chalazia in the general practice setting. DISCUSSION: Chalazia are a common cause of morbidity in people of all ages. Treatment, which is based on clinical diagnosis, can involve conservative management, intralesional steroid injection, or incision and curettage.

Recurrent giant chalazia in hyperimmunoglobulin E (Job's) syndrome.

Hyperimmunoglobulinemia E (Job's) syndrome is a rare autosomal dominant disorder appearing early in life with recurrent skin and pulmonary infections, characterized by markedly increased serum immunoglobulin E (IgE) levels. We describe a 50-year-old man with a 4-year history of recurrent, multiple giant chalazia in all eyelids. Medications and surgical intervention had produced only transient improvement. The patient had also had pulmonary and scalp infection. Laboratory tests disclosed elevated serum IgE (>1,000 IU/ml) and eosinophilia. As a result, based on the patient's history and clinical and laboratory findings, a diagnosis of Job's syndrome was made. Even though rarely, recurrent multiple giant chalazia may occur as an ophthalmic feature of Job's syndrome. Hyperimmunoglobulinemia E syndrome should be suspected in any case of recurrent giant chalazia, regardless of the patient's age. Measurement of serum IgE and eosinophils, along with internal evaluation, is essential to establish a proper diagnosis.

Subcutaneous extralesional triamcinolone acetonide injection versus conservative management in the treatment of chalazion.

OBJECTIVE: To compare the efficacy of subcutaneous extralesional triamcinolone acetonide injection versus conservative treatment for chalazion. DESIGN: Randomised controlled trial. SETTING: Eye clinics of two regional hospitals in Hong Kong. PATIENTS: Patients over 18 years old presenting with primary chalazion were randomised into two groups. In group 1, 12 patients were treated with lid hygiene, warm compresses, and chloramphenicol 1% ointment 4 times a day. In group 2, 16 patients were treated with 0.3 mL triamcinolone acetonide (10 mg/mL) injection to the subcutaneous tissue extralesionally via the percutaneous route. Exclusion criteria were: acutely infected chalazion with preseptal cellulitis, recurrent chalazion, small chalazion (< or =2 mm), and prior treatment to chalazion. MAIN OUTCOME MEASURES: Size of chalazion, recurrence of chalazion, intra-ocular pressure, and complications from treatment, including skin pigmentary change or atrophy and pyogenic granuloma. RESULTS: There was a clinically and statistically significant difference between the success rates in group 1 (58.3%) and group 2 (93.8%). In group 1, the mean prior duration of chalazion before treatment was significantly shorter in success cases than in failed cases. One patient with multiple chalazia in group 2 developed hypopigmentary skin changes at one treatment site. CONCLUSION: Subcutaneous extralesional triamcinolone acetonide injection was more effective than conservative treatment for chalazion.

Intralesional corticosteroid injection vs surgical treatment of chalazia in pigmented patients.

OBJECTIVE: To compare the outcome of intralesional corticosteroid injection and surgical treatment of chalazia. DESIGN: An interventional comparative study. PLACE AND DURATION OF STUDY: PNS Shifa, Naval Hospital, Karachi from 1st September 2002 to 31st August 2003. PATIENTS AND METHODS: During a 9-month recruitment period all patients attending PNS Shifa, Naval Hospital, Karachi, for treatment of chalazia were inducted in the study. A 141 patients with chalazia completed the study. Patients received either incision-curettage (surgical treatment/ ST group) or intralesional corticosteroid injection treatment (steroid injection/ SI group). The same procedure was repeated in unsuccessful cases only once. Z-test of proportion was used as appropriate statistical test of significance at p <0.05 for the comparison of the results between the two groups. RESULTS: The success was achieved in 59 out of 75 patients (79%) in ST group and 41 of 66 patients (62%) in SI group at first visit after two weeks (p-value <0.01). The success in ST group improved to 89% (67 out of 75 patients) after second operation and to 80% (53 out of 66 patients) in SI group after second injection of the steroid given at second week (p-value < 0.14). CONCLUSION: Intralesional steroid injection is an effective and safe alternative procedure for the treatment of chalazia. The results are comparable to surgical treatment especially after second injection. It is not associated with any serious complications although skin depigmentation is relatively common in coloured population.