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Intralesional triamcinolone acetonide injection
for the treatment of primary chalazions

ARTICLE in INTERNATIONAL OPHTHALMOLOGY · JANUARY 2014
Impact Factor: 0.55 · DOI: 10.1007/s10792-014-9904-1 · Source: PubMed

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Gordon S K Yau Jacky Wai Yip Lee
Caritas Medical Centre The University of Hong Kong
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 Yau. F. Y.1007/s10792-014-9904-1 1 23 . K. Jacky W. Lee & Can Y. Yuen International Ophthalmology The International Journal of Clinical Ophthalmology and Visual Sciences ISSN 0165-5701 Int Ophthalmol DOI 10.Intralesional triamcinolone acetonide injection for the treatment of primary chalazions Michelle Y. Wong. Y. Gordon S.

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W.6 % required tions [1. warm second TA injection for complete resolution. and complications from the meibomian gland and retained meibomian secretions. Patients usually 50 % reduction in size was achieved in 81. and symptoms of local chalazions in 4 weeks and 83 % achieved complete irritation. F. Caritas Medical Centre. [6. Kowloon. astigmatism. Y. Y. and mild topical sional TA injection is a safe. The main A chalazion. Surgical options include incision and curettage M. Lee  C. Y. Treatment options for chalazions include subsequent incision and curettage and 2. and effective mild steroids [3–5]. Y. Patient medical records were retrospectively reviewed Keywords Chalazion  Intralesional  Steroid  for all consecutive patients that received intralesional Triamcinolone acetonide TA injection by a single surgeon between January 2012 and March 2013 for the treatment of unresolved primary chalazions despite 1 month of conservative treatment. total excision.1 % required a conservative treatment with eyelid hygiene. 2]. is caused by inflammation of a blocked 50 % size reduction.0 days. The mean time to complete and may lead to complications such as corneal resolution was 15.. Introduction The dose of TA injection ranged from 2 to 6 mg (40 mg/ mL) depending on the size of the chalazion. chalazions not responding to conservative treatment. During the study period. China anaesthesia and is especially high risk when per- e-mail: skyau0303@gmail. Wong  G. Wong • Gordon S. However.7 ± 10. Surgical interven- tion is considered when conservative management fails. 7]. Yuen Received: 6 November 2013 / Accepted: 7 January 2014 Ó Springer Science+Business Media Dordrecht 2014 Abstract The aim of this study was to investigate the and may be considered as an alternative to incision and safety and efficacy of intralesional triamcinolone ace. simple. curettage in cases not responding to conservative tonide (TA) injection in the treatment of primary treatment. compression. larger lesions may be unsightly resolution in 6 weeks. treatment. Author's personal copy Int Ophthalmol DOI 10. 14.com formed in children who are not cooperative. The 123 . F. Y. K. Yau • Jacky W. also known as a meibomian gland outcome measures included time to resolution.1007/s10792-014-9904-1 ORIGINAL PAPER Intralesional triamcinolone acetonide injection for the treatment of primary chalazions Michelle Y. and more com- 38 patients were treated by intralesional TA injection. Lee • Can Y. and secondary infec- plications noted from the injections. S.3 % of present with lid swelling. systemic antibiotics procedure for the management of primary chalazions are given for associated cellulitis. Intrale. K. Occasionally. 48 chalazions from It is benign and often self-limiting. Hong Kong Special Administrative Region. A monly affects the upper eyelid. I&C is a painful procedure despite local 111 Wing Hong St. Y. Yau (&)  (I&C). Yuen acetonide (TA). or carbon dioxide laser treatment Department of Ophthalmology. pain. There were no com. mechanical ptosis. injection of triamcinolone J. antibiotic eye ointment. time to lipogranuloma.

Standard Chem & Pharm Co. The patients were given chloram- tion after failed conservative treatment with lid phenicol 1 % eye ointment three times per day to hygiene. Ltd. Visual acuity. Shanghai Sunway Pharma. No patching was required chalazion who consented for intralesional TA injec. TA ranging from 0. The inclusion criteria chalazion after disinfection of the skin with 70 % included consecutive subjects with the diagnosis of isopropyl alcohol wipes. China. compression 4–6 times per day for 10 min with a ceutical Technology Co. and a complete Recurrent chalazion ophthalmological examination were performed before Atypical features that may indicate suspicion of malignancy the injection was given.. the TA was injected transconjunctivally into the centre Patient medical records were reviewed for all of the lesion with a 27-gauge needle. 2). Topical anaesthesia (proparacaine 0. warm compression. Right complete resolution 8 days after 4 mg (0. Author's personal copy Int Ophthalmol Table 1 Exclusion criteria Data regarding duration of symptoms as well as the Exclusion criteria for study patients size (length 9 width in millimetres) and location of Concurrent eyelid infection the chalazion(s) were documented by digital coloured Duration of \1 month photographs of the chalazion(s) taken at every visit (Figs. intraocular pressure (IOP) Absence of a palpable lid chalazion by Goldmann applanation tonometry. dure [8]. Ltd.5 %) eye drops were instilled in the affected eye before the injection. Taiwan) according to the size of the This was a single centre retrospective case series lesion was injected intralesionally in the out-patient from a district hospital (Caritas Medical Centre) in treatment room (Table 3).15 mL) TA injection 123 .. and antibiotic ointment apply over the lesion and advised to continue warm (Chloramphenicol 1 %. When it was not subjects who underwent intralesional TA injection possible to evert the eyelid due to extensive swelling. three times per day for at least 1 month. Informed consent was TA injection until resolution of the chalazion. China) hardboiled egg. Shanghai. for a chalazion by a single surgeon (SKY) between the injection was given transcutaneously into the January 2012 and March 2013. The obtained before the procedure. Failure was defined as an absence of for this study. maximal chalazion diameter reduction at 2 weeks Fig. History of steroid-induced raised IOP Defaulted follow-up Technique for triamcinolone injection purpose of this study was to investigate the safety and All subjects underwent the same technique for TA efficacy of intralesional TA injection in the treatment injection. 1. Tainan City. Ethics approval by chalazion was measured clinically (length 9 width) in the Hospital Authority of Hong Kong was obtained millimetres.05 to 0. The eyelid was inverted and Hong Kong Special Administrative Region. Exclusion The patients were reviewed every 2 weeks after the criteria are shown in Table 1. Children \8 years were sedated with oral of primary chalazions not responding to conservative chloral hydrate (50 mg/kg) 30 min before the proce- treatment.15 mL (40 mg/ Patient and methods mL) (Stacort-A. after the procedure.. 1 Left patient with left upper eyelid chalazion.

5 months.8 % (22/48) of chalazions \1 cm in Gender diameter. LUL left upper lid.5 cm (Table 3).5 cm in diameter. 4. time taken for a 50 % chalazion size \1 cm.7 ± 10. The majority of or a second intralesional TA injection. Patient Characteristics Value demographics are summarised in Table 2.3 % (39/48) of chalazions [1. All means were expressed as mean ± stan- dard deviation. LLL left lower lid reduce in size by 2 weeks and underwent secondary I&C and 2. The results of our study suggest that intralesional TA All patients were of Chinese ethnicity with a mean age injection was an effective and safe treatment modality 123 . respectively. The mean duration of the chalazion before the Number of patients 38 intralesional TA injection was 2. Previous studies have shown that 29–80 % of chalazions During the study period.6 % (7/48) of chalazions failed to RUL right upper lid.3 % (40/48) of chalazions achieved Size (maximal diameter) complete resolution within 6 weeks. Seventy-seven \1 cm 22 percent (37/48) of chalazions achieved a 50 % size 1–1. RLL right lower lid.4 years (range 2–76 years).5 cm 1 achieved the same result by 4 weeks. Main outcome failed cases had chalazions with a diameter between 1 measures included the size of the chalazion during and 1.1 % (1/48) of chalazions Female 18 (47 %) [1. 52. time taken for resolution was 15. Number of chalazions 48 There were 45. patients were treated with intralesional TA injections. Right complete resolution 12 days after 4 mg (0. In total.0 days.5 cm 15 reduction at 2 weeks and 81.15 mL) TA injection Table 2 Patient demographics of 26. complete resolution.1 % (1/48) of chalazions received a second TA injection and achieved complete resolution after the TA injection. The mean time to complete reduction in the size of the chalazion. and 6 mg.1 % (25/48) of chalazions between 1 and Male 20 (53 %) 1. Failure cases were offered I&C 2 weeks after the second injection. 48 primary chalazions in 38 resolved with conservative treatment alone [9–12]. One case requiring I&C had a each follow-up interval.2 ± 19. and 2. Discussion Chalazions are a commonly encountered eye problem Results due to blockage of the meibomian glands. RLL 19 Seventy-seven percent (37/48) of chalazions LUL 15 achieved complete resolution within 4 weeks post- LLL 5 injection and 83. They were given an intralesion- Age 2–76 al TA injection of 2. 2 Left patient with right lower eyelid chalazion. without Location any complications or raised IOP noted after the RUL 9 procedure. 14. and complications from the procedure.5 cm in diameter.3 ± 2. Author's personal copy Int Ophthalmol Fig.

05 4/0.0 100 (only 1 case) Percentage of chalazions that require secondary I&C (%) 4. 17] reported a higher success rate with a Pohjanpelto who reported that larger lesions were 4-mg intralesional TA injection (81 %) compared to associated with a lower rate of resolution by intrale. Comparatively.5 cm. [16. an intralesional TA injection is a procedure that treatment.7 ± 10. However.5 cm [1.5 72.3 % of treated lesions at a mean of performed in eyes with multiple chalazions as well as 15. I&C (79 %).7 ± 10.1 ± 10. which is comparable to our about the success of TA in such large lesions. Since then. one chalazion los et al.3 ± 10. Simon findings are consistent with those of Palva and et al. Ho and Lai described the use of a 2-mg from the psychological aversion to surgery. [24] associated with more complications such as pain.8 52. Complete resolution of the chalazion was requires minimal facilities and time. two patients developed skin depigmentation at that requires injection of local anaesthesia and may be the site of the injection. however. Pavicić-Asta- recurrence [12]. and can be achieved in 83. and scarring. In addition. outside compared to I&C. An intralesional steroid injection offers the advan.1 Percentage of chalazions that resolved after a single TA injection (%) 95. Our regimen of titrating the volume of TA injection Our success rate (83 %) was similar to earlier according to the size of the lesion appears to be studies that reported success rates of 62–92 % after effective for chalazions \1. In their necessary.22-mg injection of steroid suspension compared to ions achieved complete resolution with a single TA 90 % in the I&C group [14]. various injection of 4 mg. with a slightly higher success rate in need subsequent I&C or a second TA injection.0 0 Percentage of chalazions that required a second TA injection (%) 0 4. Author's personal copy Int Ophthalmol Table 3 Dosage of intralesional TA injection and outcome of treatment according to size of lesion \1 cm 1–1.5 % of chalazions.0 days). [18] found that 95 % of chalazions decreased [1.5 cm (n = 22) (n = 25) (n = 1) Dosage of intralesional TA injection (mg/mL) 2/0.5 cm had complete resolution after a single TA in size by 80 % with no recurrence after an intrale- injection although there were no other chalazions of sional TA injection of 4–8 mg.5 24.1 6/0.1 2. On the other injection.8 18. it may be subcutaneous TA injection in which 54. \1 cm. Regarding the route of administration. Our the latter [11–15].5 cm.27 days. Similarly. simple.0 days. found that 93. sional corticosteroid injection and a high rate of Regarding time taken for resolution. apart the lesion. Chung et al. 2 mg of TA was effective and resulted in One of the earliest studies by Watson and Austin in complete resolution in 95. 0. 72 % of chalaz.1 14.4 % resolved after two injections [23].0 for primary chalazions not responding to conservative hand. with a mean time to this diameter to allow us to draw solid conclusions resolution of 15. with larger lesions more likely to I&C (87–89 %). I&C is a longer procedure series. findings (15. and less painful procedure tions can also be performed subcutaneously. A single injection was sufficient in on lesions that are close to the lacrimal punctum with most cases and only one case required a second minimal risk of damaging the adjacent eyelid injection. More recently. In the younger age group. 123 . patching of the eye complete resolution with a 3-mg subcutaneous TA is often necessary after the procedure. TA injec- tage of a quick. cooperate. and sometimes general anaesthesia is and 35.2 % of treated difficult to perform I&C as they may not be able to chalazions resolved completely with one injection.0 0 Time taken to complete resolution (days) 16.15 Distribution by size of chalazion (%) 45. It seems that chalazion size at publications have affirmed a similar success rates presentation was an important determinant of success between intralesional steroid injection (80–84 %) and for TA injection.8 % of treated chalazions achieved bleeding. in our series. structures. For 1984 found that 77 % of chalazions resolved with a larger lesions between 1 and 1. For chalazions intralesional steroid injections for chalazions [11–22].

Cottrell DG. Rosner M. Ophthalmology 93(3):405–407 10. Gowalla A. Jakobiec FA. Palva J. Silvers DN (1978) Intralesional corticosteroid therapy of Our study had limitations. Tedeschi-Reiner E. Nevertheless. Jackson TL. and outcome of treatment of chalazion by medical and nursing staff.optometry. injection for the treatment of chalazia. Am J Ophthalmol 85(6):818–821 nature and represented only a single centre. Li PS (2006) Subcutaneous extralesional 12 Nov 2013 triamcinolone acetonide injection versus conservative 5. Bosanquet RC. It was retrospective in chalazia. Schwarcz RM. patient satisfaction. Huang L. surgical treatment only one case with a chalazion[1. Kelly RJ. Mohan K. incision and curettage include yellow deposits at the site of injection [19]. Hoşal BM. Cohen BZ. Acta Clin Croat 49(1):43–48 19. Susić N (2010) Intralesional triamcinolone acetonide injection for chalazion. Hofeldt AJ. Dhir SP. Lai JS. JD. Perry HD. Saunders Company. 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