Chalazion is a localized chronic granulomatous inflammation following blockage of the meibomian glands, more commonly affecting the upper eyelids. The range of presentation can be from a benign, self-limiting nodule to a painful lid swelling complicated by corneal astigmatism and mechanical ptosis from the space-occupying effect of the chalazion in the relatively limited eyelid space [
The aim of this study was to investigate the differences in outcome of using intralesional triamcinolone acetonide (TA) injection for the treatment of primary chalazia in children and adults.
Ethics approval by the Institution Review Board was obtained and the study adhered to the Declaration of Helsinki. The authors declare no financial or proprietary interest. This was a retrospective case series from a district hospital in Hong Kong Special Administrative Region, China, with a service population of 1.8 million. Patient medical records from January 2012 to March 2013 were reviewed for all subjects that underwent intralesional TA injection for primary chalazion not responding to conservative treatment. All injections were done by a single ophthalmologist (SKY). The inclusion criteria included consecutive subjects with the diagnosis of chalazion who consented for intralesional TA injection after failure of conservative treatment with lid hygiene, warm compression, and antibiotic ointment for at least 1 month. The exclusion criteria included those with eyelid infection, chalazion duration < 1 month, nonpalpable chalazion, suspicion of malignancy, a history of steroid induced elevated intraocular pressure (IOP), or those that defaulted follow-up after the injection. Informed consent was obtained before the procedure was carried out from the patient or the patient’s legal guardian for those <18 years of age.
The outcome measures included chalazion size (length × width) in millimetres (mm), dose of TA injected, time to complete resolution of the chalazion, and complications from the procedure.
Topical anaesthesia (proparacaine 0.5%) eye drops were instilled in the affected eye before the injection. A volume of 0.05 to 0.15 mL of TA (40 mg/mL) (Stacort-A, Standard Chem & Pharm Co., Ltd., No. 6-20, Tuku., Tuku Village, Sinying District, Tainan City 73055, Taiwan) was injected intralesionally in the out-patient treatment room according to the maximal diameter of the chalazion as follows: <1 cm = 2 mg/0.05 mL TA; 1–1.5 cm = 4 mg/0.1 mL TA; and >1.5 cm = 6 mg/0.15 mL TA. The eyelid was inverted and the TA was injected transconjunctivally into the centre of the lesion with a 27-gauge needle. When it was not possible to evert the eyelid due to extensive swelling, the injection was given transcutaneously into the chalazion after disinfection of the skin with 70% isopropyl alcohol wipes. No patching was required after the procedure. The patients were given chloramphenicol 1% eye ointment three times per day to apply over the lesion and advised to continue warm compression for 4 to 6 times per day for 10 minutes each with a hard-boiled egg. The patients were reviewed every 2 weeks after the TA injection until complete resolution of the chalazion. For uncooperative or very young children, sedation was with oral chloral hydrate (50 mg/kg) was given 30 minutes before the procedure.
Patients were stratified by age: the pediatric group (<18 years old) and adult group (≥18 years old). The following were analyzed for differences between pediatric and adult groups using the Mann Whitney
In both the pediatric and adult groups, correlation of time to resolution with chalazion size and TA dose was analyzed using the Spearman’s rank correlation coefficient. All means were expressed as means ± standard deviation. Statistical significance was defined as
The mean age in the pediatric and adult group was
Differences in baseline and outcome in children versus adults.
Pediatric |
Adult |
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Mean age (years) | 7.4 ± 5.5 | 39.3 ± 16.7 | <0.0001* |
Sex (M/F) | 8/10 | 15/9 | 0.3 |
Laterality (R/L) | 11/16 | 14/10 | 0.7 |
Mean chalazion size: length × width (mm2) | 0.8. ± 0.5 | 0.8. ± 0.5 | 0.9 |
Mean TA dose (mg) | 3.5 ± 1.3 | 3.2 ± 1.1 | 0.4 |
Time to resolution (days) | 18.2 ± 11.4 | 16.5 ± 11.0 | 0.7 |
There was no significant correlation of time to resolution with either chalazion size (
Correlations of TA dose and chalazion size with time to resolution in adults and children.
Children |
Adults |
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Correlation of time to resolution with TA dose |
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Correlation of time to resolution with chalazion size |
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Chalazion is a common cause of lid inflammation and is self-limiting with conservative warm compress in 29–80% [
In our study, the pediatric and adult study group had statistically similar baseline characteristics apart from age. Despite the age differences and hence, size of the eyelids, both the pediatric and adult populations presented with a mean chalazion size of around 0.8 mm2 and subsequently received a similar dose (around 3 mg) of TA injection. TA injection was equally effective in both the pediatric and adult populations with a statistically similar recovery rate of a little more than 2 weeks in both groups (
Palva and Pohjanpelto [
Whilst TA injection is a simple and effective treatment for chalazion in both children and adults, it is important for clinicians to recognize the conditions in which TA injection should not be performed. A hordeolum can sometimes mimic a chalazion as it is a meibomian gland obstruction with a superimposed infection, usually
For those presenting with recurrent chalazia in the same location, a high index of suspicion for sebaceous cell carcinoma should exist and biopsy and histological studies are indicated [
Whilst none of the 41 subjects in our series had complications from the TA injection, clinicians carrying out such procedure should be aware of the potential complications including yellowish deposits at the injection site, elevated IOP, and skin hypopigmentations, globe perforation, traumatic cataract, microembolization, and retinal/choroidal vascular occlusions [
Our study was limited by its retrospective nature, relatively small sample size, and the lack of a control group to compare with other treatment modalities. Nevertheless, this study served its purpose in addressing that a single injection of intralesional TA for the treatment of primary chalazion was equally effective in children and adults, without any significant complications, and the rate of clinical response did not appear to be dose-dependent.
The authors declare that there is no conflict of interests regarding the publication of this paper.