What do I advise for an early Chalazion?
A patient who I had last seen three years ago came back to see me today with a three-day history of what he thought might be an early chalazion on his left lower lid. It was very close to the tear duct at the corner of the eye, and he had noticed a slight swelling and redness gradually forming over three days with a little bit of discharge. He treated it with some hot compresses and sought my assistance wondering whether he could have an incision and curettage.
When I had a look at his inflamed medial lower lid (the part of the lower lid towards the inner corner of the eye), I could see that there was a soft red swelling which was slightly tender when I looked on the slit-lamp at the meibomian glands, I could see that they were very congested, almost a pus-like discharge, and the eyelid was tender to touch. There was not a chalazion yet because the swelling was still too young and the conjunctival lining of the lower lid particularly red and inflamed. I explained to him that the two options were to either:
- Inject the early chalazion with steroid
- Have a week to 10 days worth of steroid antibiotic ointment, and then we would review him again to either doing the injection of steroid or incision and curettage if there was still a lump.
I told him that there was a good chance that it would all get better and go away and he might not need any surgery at all.
Given a choice, he considered whether having an injection today was going to be best for the early chalazion, but I explained to him that he could get a bruise from that and it could cause him a bit of discomfort. Whereas, if he had the time and the dedication to put in some eye drops four times a day initially, and then three times a day after that for up to ten days and some ointment at night, that might suit him better.
He wanted to go to work immediately today, so I explained to him that whatever he has done as an intervention, whether it be an injection now or later or an incision and curettage later, we pad the eye afterwards. We would expect it to be a bit puffy and swollen for the first 24 hours and would not recommend that he does screen work during that time.
We gave him instructions instead to use some steroid antibiotics drops four times a day for a few days, then down to three times a day for a week and to do his hot compresses twice a day and cleaning of his eyelids four times a day. We did not put him on any oral antibiotics because it was a very focal inflamed eyelid area. The main clinical finding was a vigorous inflammatory response to a low-grade infection.
I think he will do very well with the conservative medical approach rather than immediate surgery. Had I went straight in and did an incision and curettage, at this stage, it would not drain very much because of the amount of the inflammation there. I would probably give him a small fibrous scarred lump instead of a soft red swelling that he currently had. He had weighed the pros and cons of injection, surgery or medical, and opted for medical.
I will let you know how he gets on in a later blog post. The main point of writing this blog post is to explain that every chalazion is different. Treatment is not necessarily straight to incision and curettage, especially if it is an early chalazion it still has a good chance of full-resolution with medical treatment.
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