Victorian hot spoons still ease chalazia today
Chalazion in Eyelid – What the Victorians did
It seems that many of us have a fascination for medical history. The pharmacy attached to the Palacio Real in Madrid, for instance, attracts thousands of tourists a year; and the recent BBC series of programmes on the Victorian Pharmacy is another testament to the interest there is in ancient cures and treatments.
Although some of the ingredients of Victorian remedies are now either illegal or known to be dangerous (for instance many were laced with cannabis and opium) this historical documentary offered viewers a glimpse of life in the 19th century and how people attempted to cure common ailments.
While we might grimace at the very thought of leeches on our skin and sucking our blood, it is interesting to know that specially farmed medicinal leeches are successfully used today. They are particularly helpful in some plastic surgery operations and for treating a wide variety of ailments including rheumatic diseases and arthritis.
Today there are thousands of modern chemist shops the length and breadth of the UK and very few people live far from the next packet of aspirins or qualified pharmaceutical advice. However, alongside the much maligned leech, there are a few cures and treatments that have passed the test of time. In the highly technologically advanced world of ophthalmology and oculoplastics, the “Hot Spoon” treatment for the relatively common eye condition chalazia is one.
A chalazion (also known as a meibomian cyst) is an inflamed swelling that appears as a lump on either the upper or lower eyelid. It is caused by a blocked oily duct – each eyelid has approximately 27 such glands that are used to secrete oil into the tear film.
“It is not really known what causes chalazia”, explained oculoplastic surgeon Jane Olver. “Sometimes they are associated with blepharitis. Young men in their late twenties and early thirties are particularly susceptible.”
Chalazia are treated either medically or surgically and diagnosis will include an examination of the under eyelid where the visible blocked duct and a typical grey appearance would confirm it.
In an acute phase the chalazia will be a painful red and inflamed swelling. It is then that, alongside an antibiotic cream the Victorian remedy of “hot spoon bathing” can ease the discomfort.
“Hot spoon bathing involves a bowl of boiling water and a flannel around a wooden spoon. This is held close to – but not touching – the eyelid. The steam appears to draw out the heat of the chalazia reducing the inflammation and making the eye more comfortable”, said Jane. “We might incise an inflamed chalazia, but more usually an oculoplastic surgeon would wait until it is somewhat older and has settled down, then carry out the minor procedure.”
Under the current NHS guidelines, chalazia will only be surgically excised if a malignancy is suspected; it has been present for more than six months; it is situated on the upper eyelid and is interfering with vision.
So what happens to a chalazion that is left untreated?
“It used to be considered that one third would stay the same, one third would get worse and a third would get better on their own within a year; but there is no scientific proof for this supposition”, said Jane.
In fact it is impossible to know how a chalazion will evolve.
“It is all down to the body’s reaction to a blocked meibomian gland – in some rare cases it not only becomes painful in the acute phase, but also impossible to close the eye. Occasionally it can act like a cellulitis making the patient feel quite unwell; but fortunately that is quite rare.
“The body might eventually remove the lump on its own over a few years and it can be that the patient would be left with a soft swelling in the eyelid where the chalazion was.
“If it is on the upper eyelid, it will affect the sight because the eyelid will get mechanical ptosis (a drooping of the eyelid). On the upper lid, the weight of the lump can also cause an astigmatism creating blurring of the vision.
“On the lower lid it is less likely to interfere with the patient’s vision which is why it is categorised as low priority condition in the health service”, explained Jane.
“At Clinica London we have a small Treatment room where we are allowed by the Care Quality Commission to incise and drain an eyelid chalazion under local anaesthetic if the lump persists despite hot spoon bathing and antibiotic cream. It is our standard to see and treat the chalazion on the same day as that is what the patient wants. ”
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