Chalazionul

Chalazion - one of the most common eyelid conditions

Chalazionul reprezintă o umflătură nedureroasă, având aspectul unui chist, care apare în pleoapa superioară sau inferioară. Blocarea glandelor meibomiene este cauza principală, fiind asociată cu infecții bacteriene sau acumularea excesivă de sebum. Simptomele chalazionului constau în umflături roșii și sensibile la atingere, senzația de corp străin în ochi și, în unele cazuri, vederea încețoșată.

Tratamentul chalazionului implică aplicarea de comprese calde, masajul ușor al zonei afectate și administrarea de medicamente antiinflamatoare. În cazuri severe, intervenția chirurgicală poate fi necesară pentru drenarea chalazionului. Pentru a beneficia de un diagnostic corect și un tratament eficient, se recomandă consultarea unui specialist oftalmolog.

1. What is chalazion?

Chalazion or meibomian cyst is a chronic, sterile, granulomatous inflammatory lesion of the sebum-secreting glands of the eyelids, Zeis and Meibomian. In its typical form it is manifested by the 5 cardinal signs of inflammation: blush (rosette), tumor (swelling), heat (local heat), pain (pain) and functio laesa (affected eyelid function).

Chalazion is the most common inflammatory lesion of the eyelid, accounting for nearly one-third of all benign eyelid lesions globally.

2. Why does chalazion occur?

Under the probable action of bacterial enzymes, lipid degradation products from the Meibomian and Zeis glands reach the tarsal stroma and produce an inflammatory response manifested by swelling and pain. Chalazion most often occurs in the upper eyelid in one eye, but this is not the rule. Without early measures in its evolution, the inflammation can spread to several glands.

Risk factors for developing chalazion:

Chronic blepharitis
Chronic conjunctivitis
Dry eye syndrome
Acne rosacea
Seborrheic dermatitis
Obesity
Smoking
Stress
Low immunity
Poor hygiene

3. How is the chalazion evolving?

The acute evolution is either in the form of a sterile inflammation or in the form of a bacterial infection with localized cellulitis and the classic signs: pain, swelling, redness, local warmth and slightly drooping eyelid.

The subacute/chronic course appears as a round, painless, gradually enlarging nodular formation.

Although it is a benign condition, if it recurs in the presence of treatment, consideration should be given to ruling out a malignant eyelid tumour and performing an excisional biopsy.

Also, multiple studies have shown that untreated chalazions in children induce long-term refractive errors, such as oblique or vertically astigmatism.

4. How do we treat chalazion?

Local hygiene and warm compresses: in case of association with blepharitis, local hygiene at the free edge of the eyelashes is essential. This can be done with antiseptic ophthalmic wet wipes. In case of meibomian gland dysfunction, warm compresses help to melt and release old lipid secretions obstructing the glands' elimination pathway.

Omexanthin and artificial tears: in case of ocular surface dysfunction and dry eye syndrome, it is necessary to supplement the diet with essential fatty acids such as Omega 3 and to use artificial tears daily.

Intense Pulsed Light (IPL) treatmentone of the clinic's favorite procedures because it is minimally-invasive and effective, IPL treats the periocular area with light at different wavelengths that thermoregulates eyelid inversion and improves the function of the meibomian glands, treating and preventing the appearance of chalazion.

Antibiotic and anti-inflammatory drops and ointment: especially during the acute evolution of chalazion, topical treatment with antibiotics and anti-inflammatories can limit the extension and progression of the lesion, limiting bacterial infection and signs of inflammation.

Antibiotics and oral anti-inflammatories: limited to severe cases with obvious bacterial infection, but also associated with other skin conditions such as acne rosacea or seborrheic dermatitis.

Local steroid injection: can be done around or just inside the lesion, its success rates are close to 80%. Although a second injection is sometimes needed, we prefer this therapeutic option especially in the case of chalazions near the lacrimal point where the surgical approach involves more anatomical risks.

Surgical excision: after the injection of local anaesthetic, the eyelid is removed and a vertical incision is made on the inside, in the middle of the lesion. Its content is cleaned and scraped, and in some cases it may be sent to the laboratory for morpho-pathological analysis. No sutures are needed. At the end of the operation an antibiotic ointment is used and the eye is compressively bandaged. In the following days after the operation, local swelling may persist but gradually subside. Due to the ab interno approach to the eyelid, the surgery leaves no marks or scars.

For a detailed consultation and therapeutic options, we are waiting for you at the Prof. Dr. Munteanu Ophthalmology Center.

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- 26th September 2022