Chalazion (Meibomian cyst)
Chalazion is the chronic inflammation of Meibomian glands
due to blockage of its ducts.
Pathologically Chalazion is a chronic lipogranulomatous
inflammation. It is not a true cyst as it is not lined by epithelium, rather it
is lined by granulation tissue.
Pathology of Chalazion
Blockage of Meibomian duct
Stagnation of the gland content (Sebum)
When limit is crossed, it will burst and gland content will
be released into muscle and surrounding structures.
The moment sebum comes out, body immunity system recognizes
it as a foreign particle.
It will elicit chronic inflammation
Chalazion.
Clinical features of Chalazion:
Painless swelling with:
·
Overlying healthy skin (not erythematous)
·
Firm in consistency
·
Located away from the lid margin
On eversion of lid, yellow granuloma is visible.
Treatment of Chalazion:
1.
Spontaneous resolution = very less chance
2.
Intra-lesionla steroids = triamcinolone-di-acetate
(0.5 to 1.0 ml)
3.
Incision and curettage (best option)
A vertical incision through the conjunctival surface is
given. Horizontal incision is not given to avoid damage to other Meibomian
ducts. Infiltrating anesthesia is given to the submuscular layer (Dexocaine 0.5
– 1 cc)
The incision is given
through the conjunctival surface because:
1.
Easy approach
2.
To avoid scar on lid surface
3.
As inflammation is more marked posteriorly
But if it bursts into skin surface, more anterior
inflammation is present. Only then a horizontal skin incision is given. The
incision here is horizontal because the orbicularis oculi muscle is round, so if vertical
incision is given through skin, it will be injured.
That's all for today!
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As a pharmacist, I've always told people to use warm compresses for this. I'm pretty sure that they resolve spontaneous more frequently than not. I've never heard of people having to get surgery...
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