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Shima Fukuoka,1–3 Reiko Arita,2–4 Rika Shirakawa,2,3 Naoyuki Morishige2,5 1Department of Ophthalmology, Omiya Hamada Eye Clinic, 2Lid and Meibomian Gland Working Group (LIME), Saitama-shi, Saitama, 3Department of Ophthalmology, University of Tokyo School of Medicine, Bunkyo-ku, Tokyo, 4Department of Ophthalmology, Itoh Clinic, Saitama-shi, Saitama, 5Department of Ophthalmology, Oshima Eye Hospital, Fukuoka-shi, Fukuoka, Japan Purpose: To examine the changes in meibomian gland morphology and ocular higher-order aberrations (HOAs) in eyes with chalazion and its excision. Methods: Seven male patients with previous history of chalazion excision and seven control male subjects were enrolled. Changes in meibomian gland morphology (meiboscores, gland dropout, and shortening) were evaluated by using meibography equipped in a wavefront analyzer KR-1W and in a slit-lamp device BG-4M. Ocular HOAs were measured sequentially with KR-1W. The tear film breakup time (BUT) was measured. Results: Both KR-1W and BG-4M visualized meibomian gland as clear similar images. The tear film BUT (mean ± SD, 5.6±3.0 vs 9.4±2.3 seconds, P=0.025), the total meiboscore (median [interquartile range], 2 (2-3) vs 0 (0-1), P=0.007) as well as the meibomian gland dropout rate (86% vs 14%, P=0.008) and shortening rate (100% vs 29%, P=0.031) differed significantly between the patient and control groups. The first total ocular HOAs (0.142±0.063 vs 0.130±0.015, P=0.80) were similar in both groups, whereas the stability index of the total HOAs over time (0.0041±0.0048 vs -0.0012±0.0020, P=0.030) differed significantly between the patient and control groups. Conclusions: Chalazion and its excision were associated with dropout and shortening rate of meibomian glands. The morphological changes of meibomian glands in chalazion may be associated to instability of the tear film, which was suggested by the tear film BUT and the stability of ocular HOAs. Keywords: meibomian gland, meibography, wavefront analyzer, higher-order aberrations, chalazion excision

PurposeTo evaluate refractive and corneal topographic changes following excision of chalazia.MethodsThis prospective noncomparative quasi-experimental clinical trial includes consecutive patients older than 7 years with chalazia of minimum duration of 1 month who underwent excision of the lesions by an internal or external approach.ResultsOverall, 253 lids from 228 eyes of 195 patients including 110 female subjects with mean age of 31±14 years (range 7–71) were studied. Mean duration of presenting symptoms was 4±2.8 months (range 1–24). Lesions were equally distributed in medial, central, and lateral areas of the eyelids. The chalazia were single in 172 (88.2%) and multiple in 23 (11.8%) patients. Mean change in best-corrected visual acuity, spherical equivalent refractive error, and difference of keratometry (corneal astigmatism) were 0.0004±0.007 logMAR (p=0.3), −0.06±0.6 D (p=0.1), and 0.34±0.35 (pConclusionsChalazion excision can decrease corneal astigmatism and irregularity, which is more prominent in single, firm, and central upper lid lesions. These findings may have implications in pediatric patients at risk for amblyopia.

A 14-year-old girl developed a large, asymptomatic lump on the right lower eyelid a few weeks after chalazion excision. MRI showed a very large, elliptical, postseptal lesion 1.8 × 14.1 × 21.2 mm which intensified homogeneously with gadolinium. The patient underwent orbital biopsy of the lesion using a swinging eyelid approach. A dense, solid, nondraining encapsulated lesion was palpated and separated from the surrounding tissue. Histopathologic diagnosis was a granulomatous chalazion.

Purpose This study is the first to consider the effects of chalazion on corneal surface aberrations taking into account of corneal zones, and to establish the size standard for the excision of chalazion. Methods Twenty three eyes from 23 patients with central upper eyelid chalazion larger than 3 mm were recruited in this prospective study. The participants were classified into two groups, depending on size of the lesion: Group 1 with lesion size 3–5 mm and Group 2 with lesion size >5 mm Chalazion was excised by standard transconjunctival vertical incision. Corneal surface aberrations were measured using a Galilei™ analyzer and an auto-refractometer before and 2 months after the excision. Results Corneal astigmatism in all patients decreased significantly in both auto refractometer (P = 0.012) and Galilei™ (P = 0.020) measurements after chalazion excision. RMS of total HOAs decreased significantly in 6 mm (P = 0.043) and 3 mm zone (P = 0.051). The RMS of Zernike orders in the vertical and horizontal trefoil decreased significantly in 6 mm (P = 0.035) and 3 mm (P = 0.041) zone. Group 2 showed a significant decrease in corneal astigmatism in both auto refractometer (P = 0.040) and Galilei™ (P = 0.017) parameters after chalazion excision. Group 1 showed an insignificant decrease in corneal astigmatism. Unlike Group 1, the RMS of total HOAs and vertical and horizontal trefoil in 6 mm zone decreased significantly in Group 2 (P Conclusions The existence of an upper lid chalazion increases astigmatism and HOAs, especially at the peripheral cornea. Significantly induced astigmatism and HOAs are caused by chalazion >5 mm in size. Thus, we recommend the surgical excision of chalazion >5 mm in size to reduce corneal surface aberrations.

We describe a technique of chalazion excision in which multiple vertical incisions spaced approximately 1 mm apart are used to provide wide exposure of the chalazion. The entire extent of lipogranulomatous tissue can be excised under direct visualization, sparing normal tissues. No tarsoconjunctival tissue is extirpated. The vertical slats heal quickly, and horizontal incisions, which may cut across meibomian glands, are avoided.

An arteriovenous fistula secondary to a chalazion is a rare occurrence. It may follow spontaneous necrosis or surgical trauma. Digital subtraction angiography and identification of the arterial feeders combined with direct puncture of the nidus and embolization is recommended, as surgical excision becomes much easier and results in a complete excision of the lesion. Conchal cartilage graft is a useful lining material for reconstruction of the tarsal plate due to its natural curvature. It restores lid integrity and ensures a stable and functional eyelid.

Chronic chalazia that predominantly involve the anterior eyelid lamellae are most easily approached through a transcutaneous incision. We describe the use of an eyelid crease incision for chalazia of the upper lid as an alternative to incision directly over the lesion. The technique has been used successfully in 16 patients with anteriorly situated upper eyelid chalazia. The advantages of this technique include excellent exposure with minimal patient discomfort. There is no need for eyelid eversion or compression with a chalazion clamp. The inflamed tissue can be directly inspected and the controlled excision will yield a superior specimen if biopsy is contemplated.