Primary Immunodeficiency Diseases Presenting with Chalazia as the First Manifestation.

Purpose: Ocular manifestations in primary immunodeficiency diseases are rare, but they can be the initial manifestation. This can lead to the prompt diagnosis and treatment of the disease and achieve a reduction of severe systemic complications.Case Report: We present two cases where a recurrent giant chalazion was the symptom that led to the diagnosis and early treatment of a patient with X-linked chronic granulomatous disease (CGD), and a patient with hyperimmunoglobulin E syndrome.Conclusion: Even though chalazia are common and benign, children presenting with recurrent giant chalazia or torpid evolution after surgery should be investigated for immunodeficiencies to reduce the severe and potentially fatal complications of the disease.

Carcinoma de glándulas sebáceas del párpado / Sebaceous gland carcinoma of the eyelid

Los principales tumores malignos que afectan los párpados en orden de frecuencia son el carcinoma basocelular, el carcinoma de glándulas sebáceas, el carcinoma de células escamosas y el melanoma maligno. El carcinoma de glándulas sebáceas es una neoplasia originada en las glándulas sebáceas con predilección por cabeza y cuello, especialmente por las glándulas de Meibomio, aunque también puede afectar a las glándulas de Zeiss o ambas y su sitio de mayor presentación es en el párpado superior. Se presenta un paciente masculino de 46 años de edad quien presenta lesión pediculada y vascularizada en párpado inferior izquierdo posterior al drenaje de un supuesto chalazión. Se realiza rasurado de la lesión y recidiva por segunda ocasión. El carcinoma de células sebáceas se maneja con resección amplia y reconstrucción con técnica de Hughes(AU)

The main malignant tumors affecting the eyelids in an order of frequency are basal cell carcinoma, sebaceous gland carcinoma, squamous cell carcinoma and malignant melanoma. Sebaceous gland carcinoma is a neoplasm originating in sebaceous glands predominantly from the head and neck, particularly meibomian glands, though it may also affect the glands of Zeis or both, and its most common site of presentation is the upper eyelid. A 46-year-old male patient presents with a pediculated vascularized lesion on his lower left eyelid after drainage of a supposed chalazion. The lesion was shaved off and reoccurred a second time. Sebaceous cell carcinoma is managed with broad resection and reconstruction by Hughes' technique(AU)

Carcinoma de glándulas sebáceas del párpado / Sebaceous gland carcinoma of the eyelid

Los principales tumores malignos que afectan los párpados en orden de frecuencia son el carcinoma basocelular, el carcinoma de glándulas sebáceas, el carcinoma de células escamosas y el melanoma maligno. El carcinoma de glándulas sebáceas es una neoplasia originada en las glándulas sebáceas con predilección por cabeza y cuello, especialmente por las glándulas de Meibomio, aunque también puede afectar a las glándulas de Zeiss o ambas y su sitio de mayor presentación es en el párpado superior. Se presenta un paciente masculino de 46 años de edad quien presenta lesión pediculada y vascularizada en párpado inferior izquierdo posterior al drenaje de un supuesto chalazión. Se realiza rasurado de la lesión y recidiva por segunda ocasión. El carcinoma de células sebáceas se maneja con resección amplia y reconstrucción con técnica de Hughes(AU)

The main malignant tumors affecting the eyelids in an order of frequency are basal cell carcinoma, sebaceous gland carcinoma, squamous cell carcinoma and malignant melanoma. Sebaceous gland carcinoma is a neoplasm originating in sebaceous glands predominantly from the head and neck, particularly meibomian glands, though it may also affect the glands of Zeis or both, and its most common site of presentation is the upper eyelid. A 46-year-old male patient presents with a pediculated vascularized lesion on his lower left eyelid after drainage of a supposed chalazion. The lesion was shaved off and reoccurred a second time. Sebaceous cell carcinoma is managed with broad resection and reconstruction by Hughes' technique(AU)

The Association of Demodex with Chalazia: A Histopathologic Study of the Eyelid.

PURPOSE: To investigate the association of Demodex with chalazia and to describe the associated histopathologic changes in the eyelid tissue. METHODS: In a retrospective histopathologic case-control study, 78 ectropion/entropion repair eyelid wedge resections were examined. Serial sections were obtained on formalin-fixed, paraffin-embedded tissues, stained with hematoxylin-eosin and studied by light microscopy. Thirty-eight patient specimens had evidence of chalazia and 40 did not. The main outcome measures included quantification of total eyelid hair follicles, meibomian glands, Demodex folliculorum and Demodex brevis; determining the presence of lipogranulomatous and non-lipogranulomatous inflammation, hair follicle and meibomian gland duct dilatation and hyperkeratinization, and meibomian gland acinar dilation, keratinization, and atrophy. RESULTS: There was a significantly greater mean number of D. folliculorum in biopsies with chalazia, when compared with biopsies without chalazia (5.55 vs. 2.68, p = 0.044). The presence of D. folliculorum was strongly associated with hair follicle duct dilatation and hyperkeratinization and with perifollicular nongranulomatous inflammation (p = 0.00). Hair follicle duct dilatation, hyperkeratinization, and perifollicular inflammation were also independently associated with chalazia (p = 0.040 and 0.031, respectively). D. brevis was observed only in meibomian glands with chalazia (mean = 0.342), but this finding did not reach statistical significance; p= 0.068. CONCLUSION: While the authors cannot establish causality between Demodex and chalazia, these findings suggest that D. folliculorum indirectly may be involved in the pathogenesis of chalazia via its effect on the anterior eyelid margin.

Demodex mites as potential etiological factor in chalazion - a study in Poland.

The aim of the study was to investigate the presence of Demodex in the hair follicles of eyelashes and their potential participation in the aetiology of chalazion in patients in Poland. The study of the correlation between the presence of Demodex spp. and chalazion has never been performed in patients in Europe. There is, therefore, a justified necessity to check whether Demodex mites can be a potential risk factor in the development of chalazion in the European population. The samples were examined by light microscope, using standard parasitological methods. A positive result was assumed in the presence of Demodex spp. Demodex was detected in 91.67% of patients with a chalazion. The presence of Demodex was found in subjects from all examined age groups. The results of statistical analysis unambiguously determined the existence of an interrelationship between the presence of Demodex and chalazion. Our results clearly indicate the existence of a correlation between the occurrence of Demodex spp. and chalazion. Confirmation of the positive correlation between Demodex and chalazion in a European population provides further evidence for the pathogenic role of Demodex in the development of eye diseases.

Granuloma aséptico facial idiopático / Idiopathic facial aseptic granuloma

El Granuloma Aséptico Facial Idiopático (GAFI) es un proceso dermatológico propio de la edad pediátrica, caracterizado por la presencia de un nódulo inflamatorio adquirido de larga evolución en la piel facial, sin dolor ni calor local. Su localización habitual es en la mejilla, en el triángulo que forma el ángulo externo del ojo, el lóbulo de la oreja y la comisura labial. Se han postulado varias hipótesis respecto a su etiología, como su relación con traumatismos sutiles o picaduras de insecto o bien se trate de un residuo embriológico o, la más aceptada en la actualidad, de una forma peculiar de manifestación de la rosácea en la infancia. Si bien en la literatura solo se han reportado 45 casos, algunos autores señalan que puede tratarse de un proceso poco conocido y no tan infrecuente en la edad infantil. Consideran así mismo que su apariencia clínica, localización y evolución características pueden ser suficientes para su diagnóstico, evitando así intervenciones diagnósticas y terapéuticas agresivas en una edad tan sensible al dolor, y con la posibilidad de secuelas cicatriciales en la cara. Presentamos un nuevo caso de GAFI, manejado de un modo conservador, tras ser diagnosticado a tenor de sus manifestaciones clínicas y evolutivas (AU)

The idiopathic facial aseptic granuloma (IFAG) is a cutaneous condition characteristic in the pediatric age which is characterized by an acquired inflammatory painless nodule of long-term evolution in the facial skin and presents no local heat. It usually appears on the cheeks, in the triangle formed by the external angle of the eye, the earlobe and the labial commissure. Several hypothesis have been postulated on its etiology: its appearance could be related to a slight injury or an insect bite or could be an embryological remnant. The most widely accepted hypothesis is that it could be a particular manifestation of rosacea in infants. Although only 45 cases have been reported in the literature, some authors point out that it could be a little known process and not so uncommon in the pediatric age. It is also considered that its clinical characteristic aspect, localization and evolution could be sufficient for correct diagnosis, thus avoiding invasive diagnostic interventions and aggressive therapies in such a sensitive age to pain and with the possibility to leave scars in the child’s face. The present is a new case of IFAG handled in a conservative way after diagnosis based on its evolutional and clinical manifestations (AU)

Retained soft contact lens masquerading as a chalazion: a case report.

A misplaced contact lens is a common ocular emergency presenting to the eye casualty. We report a case of lost soft contact lens which migrated in the lid and presented 13 years later with symptomatic eye lid swelling. Authors in the past have reported migration and subsequent retention of lost hard lenses in locations such as the superior fornix and eyelid. To the best of our knowledge, misplaced soft contact lens masquerading as a chalazion has not been reported in the literature. Consideration should be given to the possibility of a retained contact lens in a patient with a history of a lost or misplaced lens, and examination of the ocular surface with double eversion of the upper lid should be performed.

Associated morbidity of chalazia.

PURPOSE: Chalazion may be associated with some local and systemic conditions. We studied the prevalence of various conditions among patients with chalazion. METHODS: A retrospective observational case-control study of all the members who were diagnosed with chalazion in the Central District of Clalit Health Services in Israel (years 2000-2008; n = 9119) and 9119 age- and gender-matched controls randomly selected from the district members. We calculated the prevalence of various ocular, systemic, and demographic conditions as risk factors for chalazion. RESULTS: Demographically, a significant (P < 0.0001) tendency to develop chalazion was found in the population of lower socioeconomic class, in the population living in urban areas, in young females (10-29 years), in older men (older than 60 years), and in non-Ashkenazi Jews. The following risk factors of chalazion were statistically significant: blepharitis [odds ratio (OR), 6.2], rosacea (OR, 2.9), gastritis (OR, 1.4), anxiety (OR, 1.5), irritable bowel syndrome (OR, 1.7), and smoking (OR, 1.2). Diabetes (OR, 0.8) and hypothyroidism (OR, 0.8) were significantly less prevalent among chalazion patients. CONCLUSIONS: Some systemic conditions are significantly more prevalent and some are significantly less prevalent among patients with chalazion. Better understanding of the pathophysiological association between those diseases and chalazion may help in its treatment and prevention.

Budesonide-induced periorificial dermatitis presenting as chalazion and blepharitis.

We report a case of periorificial dermatitis caused by suboptimal inhalation of budesonide for asthma. The initial skin lesions presented in the eye surroundings, leading to diagnostic difficulties and treatment of presumed chalazion and staphylococcal folliculitis. After several months, the patient developed perioral papules and pustules and was diagnosed with periorificial dermatitis. He was efficiently treated with topical metronidazole and oral erythromycin.

[Sebaceous carcinoma. Study of two cases]. / Carcinoma de glándulas sebáceas: presentación de dos casos clínicos.

CLINICAL CASES: A 94-year-old woman, who had had a chalazion for a period of 8 months, presented because of thickening of the eyelid with necrosis, madarosis and adenopathy. A 67-year-old woman, previously operated on for a sebaceous carcinoma, presented because of reddening of the conjunctiva and eyelid. Clinical evaluation revealed inflammation of the eyelid and an irregular and erythematous superior bulbar conjunctiva with disruption of the limbal architecture. DISCUSSION: A sebaceous carcinoma is a tumour which is difficult to diagnose and treat, because it can be patchy and has a tendency to pagetoid dissemination. Diagnosis requires a biopsy of the lesion and mapping of biopsies from the conjunctiva of the eyelid and eyebrow. The subsequent treatment depends on the extent of the tumour, and may involve simple cleavage, topical mitomycin C, radiotherapy or exenteration of the eyebrow.

Cutaneous and ocular signs of childhood rosacea.

UNLABELLED: Objectives To describe the clinical features of cutaneous and ocular manifestations of childhood rosacea, to propose diagnostic criteria, and to emphasize the possible severity of ocular complications in this age group. DESIGN: Retrospective study. SETTING: Tertiary referral center. Patients Children aged 1 to 15 years who had received a diagnosis of cutaneous and/or ocular rosacea and were seen between January 1, 1996, and December 31, 2005. RESULTS: Of 20 patients, 11 had ocular and cutaneous rosacea, 6 had isolated cutaneous involvement, and 3 had isolated ocular involvement. Dermatologic examination results were sufficient to diagnose rosacea in 12 of the patients (60%). The most common presentation was a papulopustular eruption on a telangiectatic background. In 11 patients (55%), ocular involvement preceded the skin eruption. Among the ophthalmologic manifestations, chalazions and blepharoconjunctivitis were the main presenting symptoms; keratitis was observed in 4 patients and corneal ulcers in 2. Ten patients were treated with oral metronidazole. Intermittent treatment for at least 3 months was used to avoid neurologic toxic effects and to achieve complete remission. Conclusion Although rare, childhood rosacea should be recognized because of the possible severity of ocular involvement.

[Masquerade of sebaceous gland carcinoma as a rapidly recurring "chalazion", a case report]. / Maskerade eines Talgdrüsenkarzinoms durch ein rasch rezidivierendes "Chalazion", eine Kasuistik.

PURPOSE: Demonstration of the importance of surgical excision and histological examination in presence of an apparently harmless tumoral alteration of the eyelids. CASE PRESENTATION: We report the case of a 65 year old patient suffering from systemic lupus erythematosus who noted a tumoral lesion on his left lower eyelid. Suspecting a chalazion, his dermatologist simply performed a cauterization. Six weeks later, a recurrence of the tumor appeared at the same location, and again, cauterization was done. A few weeks later, the patient consulted our clinic with a polycyclic tumor of 5 mm in diameter, involving the lid margin of the temporal part of the lower left eyelid. The patient had only moderate signs of blepharitis. There were no palpable preauricular and cervical lymph nodes. Suspecting a malignant tumor, the entire tumoral lesion was removed surgically. HISTOPATHOLOGY: The histopathologic examination showed a highly differentiated sebaceous gland carcinoma, most probably originating from a meibomian gland. The margins of the excision were found to be tumor-free. DISCUSSION: Sebaceous cell carcinoma is a rare entity. Depending on its histological differentiation it can be highly malignant. Infiltrative, and can metastasize. The mortality may reach 30% if low differentiation is present. As illustrated in the present case, the lesion may masquerade a chalazion. Therefore, in case of atypical lesion of the eyelid region complete surgical removal followed by a histopathological examination should be performed.

Chalazion coexisting with dacryolithiasis.

A 41-year-old woman presented with a painless hard subcutaneous nodule in the right upper eyelid. The lesion was diagnosed clinically as pilomatricoma and removed surgically. Histological examination disclosed a granulomatous lesion composed mainly of mononuclear cells with a foamy appearance and multinucleated giant cells with some admixture of granulocytes, plasma cells, and lymphoid cells. Lipid droplets and dilated ductal structures containing an eosinophilic fibrillar substance were observed in and around the granulomatous lesion. In addition, an intraductal dacryolith was seen near the granulomatous lesion. We finally diagnosed this case as chalazion; the coexisting dacryolithiasis was considered to be involved in the pathogenesis of chalazion.