Injections for Chalazia?

Ben Simon et al1Ben Simon G.J. Huang L. Nakra T. et al.Intralesional triamcinolone acetonide injection for primary and recurrent chalazia is it really effective?.Ophthalmology. 2005; 112: 913-917Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar performed a thorough evaluation of the safety and efficacy of intralesional triamcinolone injection in 155 consecutive cases of primary and recurrent chalazia. Most cases resolved with an average of 1 to 2 injections, and the authors suggested that injections be considered as an initial treatment in chalazia. I point out some restrictions to the use of triamcinolone in chalazia. Bacteria and viruses have been implicated in the pathogenesis of many chalazia.2Mansour A.M. Chan C.C. Crawford M.A. et al.Virus-induced chalazion. Eye 2005 Mar 4 [epub ahead of print]. 2005Google Scholar Meibomian glands consist of tubuloalveolar sebaceous glands, arranged vertically throughout the tarsal plate, with the acini projecting into a central canal that opens in front of the mucocutaneous junction of the eyelid margin as a very small orifice. The canal is composed of layers of cells with a basement membrane rising to the orifice. Because the palpebral conjunctiva extends all the way to the orifices of the meibomian glands at the lid margin, it is easy to see how a viral or bacterial conjunctivitis might clog the tiny orifices by edema and desquamation, or the virus or bacterial infection could spread to the meibomian glands with secondary alterations of the lipid secretions and of the bacterial flora. Mansour et al2Mansour A.M. Chan C.C. Crawford M.A. et al.Virus-induced chalazion. Eye 2005 Mar 4 [epub ahead of print]. 2005Google Scholar previously described 26 patients who developed chalazia related to a preexisting viral conjunctivitis. There are 3 subsets of chalazia for which triamcinolone injections may not be the treatment of choice: chalazia with purulent component, virally induced chalazia, and atypical chalazia (masquerade diseases such as metastatic lid disease and sebaceous carcinoma). Some infected chalazia have overlying purulent material (when we incise the chalazion or when we milk it). I routinely try to milk the chalazion to express meibum or purulent discharge. In a few instances, I can milk part of the lesion and prescribe systemic antibiotics with frequent eyelid massage. Follicular conjunctivitis, history of upper respiratory tract infection, preauricular lymphadenopathy, and keratitis can help us in diagnosing virally induced chalazia.2Mansour A.M. Chan C.C. Crawford M.A. et al.Virus-induced chalazion. Eye 2005 Mar 4 [epub ahead of print]. 2005Google Scholar The treatment of chalazia related to viral conjunctivitis is conservative.2Mansour A.M. Chan C.C. Crawford M.A. et al.Virus-induced chalazion. Eye 2005 Mar 4 [epub ahead of print]. 2005Google Scholar I would advise the use of intralesional corticosteroids with extreme caution in virus-related chalazia due to the theoretical risk of reactivation of herpetic keratitis, prolongation of virus shedding, and potential risk of colonization of the virus of the meibomian glands and potential long-term risk for neoplasia (papillomaviruses, herpes virus,2Mansour A.M. Chan C.C. Crawford M.A. et al.Virus-induced chalazion. Eye 2005 Mar 4 [epub ahead of print]. 2005Google Scholar and murine leukemia virus2Mansour A.M. Chan C.C. Crawford M.A. et al.Virus-induced chalazion. Eye 2005 Mar 4 [epub ahead of print]. 2005Google Scholar seem to infect sebaceous and meibomian glands, with a high percentage of patients with sebaceous carcinoma of the eyelid showing evidence of infection with the papillomavirus3Hayashi N. Furihata M. Ohtsuki Y. Ueno H. Search for accumulation of p53 protein and detection of human papillomavirus genomes in sebaceous gland carcinoma of the eyelid.Virchows Arch. 1994; 424: 503-509Crossref PubMed Scopus (60) Google Scholar). Rare complications of intralesional corticosteroids such as conjunctival necrosis at the site of injection, steroid-induced ptosis,4Mansour A.M. El-Dairi M.A. Shehab M.A. et al.Periocular corticosteroids in diabetic papillopathy.Eye. 2005; 19: 45-51Crossref PubMed Scopus (24) Google Scholar and potential steroid-induced granuloma5Dietrich C.L. Smith C.E. Epidural granuloma and intracranial hypotension resulting from cervical epidural steroid injection.Anesthesiology. 2004; 100: 445-447Crossref PubMed Scopus (26) Google Scholar (are we clogging the meibomian orifices with triamcinolone so that recurrences are more frequent?) have been reported here. Intralesional Triamcinolone Acetonide Injection for Primary and Recurrent Chalazia: Is It Really Effective?OphthalmologyVol. 112Issue 5PreviewTo evaluate the safety and efficacy of intralesional triamcinolone acetonide (TA) injection in primary and recurrent chalazia. Full-Text PDF Author ReplyOphthalmologyVol. 113Issue 2PreviewWe appreciate Dr Mansour’s comments regarding our report on the efficacy of triamcinolone acetonide injections in primary and recurrent chalazia. Full-Text PDF