Common inflammatory and infectious conditions of the eyelid.

Patients with infection or inflammation of the eyelid will often first present to their primary care physicians with symptoms such as redness, swelling, tearing, itchiness, or a foreign body sensation. There are a variety of conditions that affect the eyelid which can cause such symptoms, and the exam and history can help a provider differentiate some of the more common conditions. This article will provide a comprehensive review of the background, diagnosis and management of dry eye disease, chalazion, hordeolum (stye), and preseptal cellulitis.

Effects of chalazion excision on ocular aberrations.

PURPOSE: The goal of this study was to compare higher-order aberrations before and after upper lid chalazion excision. METHODS: Fourteen eyes from 12 patients (8 females, mean age: 28.7 ± 2.7 years) with upper lid chalazion were enrolled in this prospective interventional case series. Chalazia were excised by standard transconjunctival vertical incision. Ocular aberrations were evaluated by aberrometry (ZyWave) before and 2 months after chalazion excision. RESULTS: Root mean square of total higher-order aberrations decreased from 0.67 ± 0.12 to 0.43 ± 0.15 µm (P = 0.012) after excision. The root mean square of Zernike orders in the vertical and horizontal trefoil and horizontal coma were decreased after excision. Orbscan IIz tomography showed a statistically significant decrease in 5 mm zone irregularity (P = 0.027) and an increase in minimum simulated keratometry after surgery (P = 0.046). CONCLUSIONS: Chalazion increases higher-order aberrations, as measured by the Hartmann-Shack aberrometer, which could affect the preoperative evaluation and results of refractive surgery, especially wavefront-guided approaches. Chalazion excision could reduce ocular aberrations and is recommended before refractive surgeries.

Intralesional triamcinolone acetonide injection versus incision and curettage for primary chalazia: a prospective, randomized study.

PURPOSE: To compare treatment outcomes of intralesional triamcinolone acetonide (TA) injection with incision and curettage (I&C) for primary chalazia. DESIGN: Prospective, randomized clinical trial. SETTING: Institutional. STUDY POPULATION: Ninety-four patients with primary chalazia after failed conservative treatment were randomized to either intralesional TA injection (4 mg) or I&C performed under local anesthesia. All patients underwent comprehensive eye examinations that included digital photography of the lesion. Complete resolution was defined as lesion regression of 95% to 100%. Treatment was considered a failure if no resolution was achieved after the first attempted I&C or TA injection. MAIN OUTCOME MEASURES: Lesion resolution measured as 95% to 100% regression. RESULTS: Ninety-four patients participated in the study: 42 underwent I&C and 52 underwent TA injection as the first treatment. Complete resolution was achieved in 33 (79%) of 42 patients in the I&C group and in 42 (81%) of 52 patients in the TA group (P=.8, chi-square analysis). The average time to resolution in the TA group was 5 days, with most patients (48/52; 92%) having received a single injection and 4 (8%) of 52 patients having received 2 injections. TA precipitates were detected in 6 (11.5%) of 52 patients and resolved spontaneously. There were no complications, such as eyelid depigmentation, increased intraocular pressure, or any loss of vision, in either group. CONCLUSIONS: Intralesional TA injection is as effective as I&C in primary chalazia. Injection may be considered as an alternative first-line treatment in cases where diagnosis is straightforward and no biopsy is required.

Case report: Chalazion and its features visualized by ultrahigh resolution optical coherence tomography.

PURPOSE: The purpose of this case report is to highlight the clinical characteristics of a recurrent chalazion through the use of digital photography and ultra-high resolution optical coherence tomography (UHROCT). CASE REPORT: A single case is presented, along with digital biomicroscopic photographs and UHROCT images. DISCUSSION: A review of the literature describing the histopathological and associations of chalazia and other disorders, suggest it may be possible to differentiate different eyelid conditions based on their clinical manifestations and appearance on UHROCT tomograms. Based on the images presented here, it appears that this case is typical of a post-menopausal incidence of chalazion and risk for acne rosacea.

Effect of chalazion excision on refractive error and corneal topography.

PURPOSE: To evaluate refractive and corneal topographic changes following excision of chalazia. METHODS: This prospective noncomparative quasi-experimental clinical trial includes consecutive patients older than 7 years with chalazia of minimum duration of 1 month who underwent excision of the lesions by an internal or external approach. RESULTS: Overall, 253 lids from 228 eyes of 195 patients including 110 female subjects with mean age of 31-/+14 years (range 7-71) were studied. Mean duration of presenting symptoms was 4-/+2.8 months (range 1-24). Lesions were equally distributed in medial, central, and lateral areas of the eyelids. The chalazia were single in 172 (88.2%) and multiple in 23 (11.8%) patients. Mean change in best-corrected visual acuity, spherical equivalent refractive error, and difference of keratometry (corneal astigmatism) were 0.0004-/+0.007 logMAR (p=0.3), -0.06-/+0.6 D (p=0.1), and 0.34-/+0.35 (p<0.0001) after surgery, respectively. Corneal topographic analysis revealed significant changes in surface regularity index (0.13), surface asymmetry index (0.09), and potential visual acuity (0.06-/+0.1 logMAR) after the procedure (p<0.0001 for all comparisons). Single, central, and firm chalazia were compared with multiple, peripheral, and soft lesions; change in difference of keratometry and spherical equivalent were 0.75-/+0.42 D versus 0.22-/+0.15 D (p=0.001) and -0.35-/+0.19 versus -0.11-/+0.30 D (p=0.1), respectively, implying more induced astigmatism with the former type of lesions. CONCLUSIONS: Chalazion excision can decrease corneal astigmatism and irregularity, which is more prominent in single, firm, and central upper lid lesions. These findings may have implications in pediatric patients at risk for amblyopia.

Sebaceous carcinoma of the eyelids: a review of six cases.

Sebaceous carcinoma of the eyelid, although rare, carries a grave prognosis when diagnosed late. It may be mistaken by the unsuspecting ophthalmologist for a chalazion or chronic blepharoconjunctivitis. Six cases are presented. Three patients were in their fifth decade and the remaining three were over seventy. The latter group presented with advanced local disease and had poorly differentiated tumours. The two oldest patients died of metastasis within 54 months of presentation despite total excision of the lid tumour. This review demonstrates the problems encountered in diagnosis and management.