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gland which may be of benefit if the lesion is This technique is safe and effective. There has
small2. Vigorous massage can cause further been one reported case of a serious complication
extravasation of the meibomian secretions into resulting in both retinal and choroidal vascular
the surrounding tissue, spreading the occlusion from embolisation of the injected
granulomatous inflammation2. Regrettably, this steroid15. To minimise the chances of this
treatment is not very effective, resolving only occurring, practitioners should aspirate for blood
around 40% of these lesions13,14. before injecting, take care to inject slowly, and
Chalazia which fail to resolve with avoid heavy digital pressure during and after
conservative management may be treated with an injection16. Other less serious complications
intralesional injection of steroid14. This technique include pain on injection, depigmentation of the
increases the resolution rate to 80%, while eyelid at the injection site, temporary skin Figure 9
combining the conservative therapy with steroid atrophy and subcutaneous white (steroid) Forceps pointing to excised gland
injection increases the resolution rate to 90%14. deposits (Figure 5)5. after it has been cleaned of debris
Since the chalazion is encapsulated by
connective tissue, there is little room for Xylocaine (lidocaine). The eyelid is everted and a
space-occupying steroid medication. Therefore, traction suture is placed through the eyelid
a steroid of increased concentration such as margin. Then a chalazion clamp is positioned
triamcinolone acetomide (Kenalog-40), a over the lesion. This helps stabilise the eyelid
40mg/ml concentration works well since and assists in hemostasis. A surgical #11 or #15
only a 0.10-0.20cc dose needs to be injected straight blade or a circular trephine blade is
(Figure 4). used to incise the involved meibomian gland
The chalazia can be injected through the skin through the conjunctival surface. A curette is
surface or the conjunctival side using a 1ml Figure 5 then used to scrape out the chronic
tuberculin syringe with a 27-gauge or 30-gauge Subcutaneous white (steroid) deposits granulomatous debris.
needle. The steroid suspension should be after intralesional triamcinolone injection The chalazion clamp and traction suture are
injected into the centre of the lesion. If injection removed and the eyelid is repositioned. Digital
is performed from the conjunctival side, several The most reliable therapy involves surgical pressure is applied until all the bleeding has
drops of a topical anaesthetic to numb the excision of the affected meibomian gland stopped. The eye is treated with antibiotic
puncture site and minimise blinking. Injection (Figures 6-9). The surrounding eyelid tissue ointment, which the patient should continue to
through the skin surface of the eyelid requires no needs to be injected with the anaesthetic use two times a day for five to seven days. The
anaesthesia. Some practitioners prefer to use a patient should be re-evaluated after about two
chalazion clamp, but this is not always necessary. weeks.
Chalazia typically resolve within one or two weeks There are usually few complications from this
after a single injection, but larger chalazia may surgery. The eyelid may be swollen and
require a second injection. discoloured after the surgery for several days to
one week. Occasionally, a subconjunctival
haemorrhage can also develop, but this will
resolve without incident (Figure 10). On rare
occasions, the chalazion may recur if the
surgical excision was incomplete.
Figure 6
Injection of eyelid with the anaesthetic,
Xylocaine (lidocaine)
Figure 10
Child with eyelid ecchymosis and
subconjunctival haemorrhage after surgical
excision of chalazion
Figure 7
Pyogenic granuloma
Chalazion clamp and traction suture in place
Signs and symptoms
A pyogenic granuloma may be seen after trauma
or surgery, or may form over inflammatory
Figure 4 lesions, such as chalazia. These nodules occur
Setup for steroid injection for chalazia rarely in the anophthalmic socket following
Locally injected steroid suspension works enucleation of the eye and at the margin of
because a chalazion is composed of steroid- corneal transplants17.
sensitive histocytes, multi-nucleated giant cells, These lesions occur on the conjunctival side
lymphocytes, plasma cells, polymorphonuclear of the eyelid and are fleshy, red, usually sessile
leukocytes, and eosinophils4. The injected steroid Figure 8 with a palpable rigid either non-tender or
suppresses additional inflammatory cells and Currette adjacent to granulomatous debris moderately tender presentation (Figure 11).
impedes chronic fibrosis. scraped from inside the meibomian gland Microscopically, a pyogenic granuloma is
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