Lumps and Bumps on the Eyelid – Part II

Hello everyone! I hope you all are safe and are staying healthy! I once again thank you all for the amazing response to the previous post. There were multiple requests to discuss the surgical options for the treatment of chalazion. So here we go!!

DISCLAIMER: Now, this might be a little detailed for people who want to know it all while others can skip the extreme details if they wish to!

As discussed in the earlier post: this is how a chalazion looks.

It basically is a chronic lipogranulomatous inflammation, in simple words – long standing infection involving the eyelid oil glands, more commonly, meibomian glands.

There are >40 meibomian glands in the upper eyelid and >20 in the lower eyelid. Any of these glands can be involved. The secretions may get blocked and infected, and when left untreated can lead to chalazion formation.

We have 3 ways to treat this lesion:

Conservative management

• WARM COMPRESS, WARM COMPRESS and WARM COMPRESS.
• Continue for 6-8 weeks, regularly, at least twice daily.
• Each sitting: 10 mins.NO EYE DROPS, NO EYE OINTMENT, NO MEDICATIONS.
• For details on Warm Compress: Refer to the previous post.
• Works for most if strictly adhered to, but may not work for some. If the swelling fails to resolve, we can use the other 2 options.

Incision and curettage or the ‘CUT’

It is the most widely practised treatment option for chalazion.

1. What is the technique?
   • The technique is rather simple. (see VIDEO)
   • In this technique a small cut is made from the inside and all the collected secretion is drained.

2. What is the time duration for healing?
   • It can take 7-10 days for healing to occur.


3. What are the post-operative medications to be used?
   • Analgesics or pain killers are given to reduce the pain and also the swelling that appears after the procedure.
   • Local antibiotic ointment at night for 5-7 days can be applied similar to how Kajal/kohl is applied to the lower eyelid.
   • Warm compresses – VERY VERY IMPORTANT to continue till healing is complete.


4. No ORAL ANTIBIOTICS?
   1. No not needed.

Intralesional injection treatment

There are situations where to save your water drainage apparatus or your eyelashes, we might opt for lesser invasive options like injections into the swelling.
In this way we preserve the beauty of your eyelids and face.

CHALLENGE:

The challenge here is to tackle the recurrences that may occur either due to the underlying untreated condition (refer: previous post), or due to incorrect technique. If intralesional injection is used, there may be a small residual lesion left behind, which may either need repeat injection or the surgical procedure.

If the lesion recurs in exactly the same position, please consult your eye doctor. Till then continue warm compresses.

NOTE: Sometimes these swellings may mimic a serious condition of the eyelid – therefore any doubts or concerns, please consult your eye doctor. Also, you can freely write to me for any further clarifications if needed.

I hope this was helpful. I will come up with more frequently encountered questions in the clinic with logical and scientific explanation for the same.

Nandini Bothra
Consultant, Govindram Seksaria Institute of Dacryology,
Ophthalmic Plastic Surgery Services,
L V Prasad Eye Institute, Hyderabad.
Email id: nan_bothra@yahoo.com

^{Reference: Bothra N, Ali MJ, Naik MN. To know when to prick!!. Saudi J Ophthalmol. 2017;31(3):203‐205.}