OPT 221 Eyelids: Noninfectious, inflammatory

What is blepharochalasis?

recurrent episodes of inflammatory edema of the eyelids

What is the etiology of blepharochalasis?

-Unknown

-Associated with Ascher Syndrome

What are characteristics of Ascher syndrome?

-eyelid swelling

-narrow horizontal palpebral fissure

-lip swelling (double lip sign)

-euthyroid (non toxic)

-goiter

What demographics are more affected by blepharochalasis?

-typically begins in teens to 20s

-women>men

-bilateral>unilateral

What are symptoms of blepharochalasis?

-Painless eyelid swelling

-Droopy eyelids with fine wrinkles

What are signs of blepharochalasis?

-Eyelid edema

-Atrophy and laxity of the upper eyelid tissues due to repeated episodes of edema (thin, stretched, redundant skin with fine wrinkles, ptosis, deep superior sulci, lacrimal gland prolapse)

How is blepharochalasis managed?

-self limiting within a few days but can recur (episodes become less frequent)

-oral acetazolamide in conjunction with topical hydrocortisone, maybe oral doxycycline

-oculoplastic surgery

What are clinical pearls for blepharochalasis?

-look at patient outside of slit lamp first

-recurrent cases more likely to cause laxity and wrinkling

-blepharoplasty improves cosmesis

What is a chalazion?

Obstruction and inflammation of a meibomian gland with resultant accumulation/formation of lipogranulomatous material

What is an anterotarsal chalazion?

external; anterior to the tarsal plate (skin side)

What is an retrotarsal chalazion?

internal; posterior to the tarsal plate (conjunctiva side)

What is the etiology of chalazion?

commonly due to chronic blepharitis, ocular rosacea, or MGD

-inflammation within MG, gland of zeis

-may be from pervious hordeolum

What demographics are commonly affected by chalazion?

-lower SES

-urban population

-more common in women 10-29 and men >60

-usually unilateral but can switch between both eyes

What are symptoms of chalazion?

-bump on eyelid (stye, puffy)

-painless, mild tenderness

-discharge or drainage

What are signs of anterotarsal chalazion?

visible or palpable nodule pointing anteriorly through the skin

What are signs of retrotarsal chalazion?

visible or palpable nodule pointing posteriorly through the palpebral conj (must invert lid)

How is a chalazion managed?

-Warm compress with digital massage to express the contents (At least BID, for 5-10 minutes Massage the eyelid toward the lashes)

-Eyelid hygiene in addition to warm compress for blepharitis

-Oral doxycycline (esp in ocular rosacea or MGD) 100mg bid x 2wks (prominent chalazion) 50mg bid x 4 weeks, then consider 50mg qday for another 2 months (MGD > chalazion)

What is the suggestion of 6 for intralesional corticosteroid injection (kenalog-40)?

Success rate ~60% for lesions <6 months in duration and <6 mm in size

*never inject into an active infection

Describe the steps of chalazion surgical intervention.

1. Wear gloves, topical proparacaine, alcohol swab/prep injection site

2. 27 gauge

Draw up ~0.2-0.3mL (shake bottle!)

4. Apply clamp

5. External or internal approach

6. Bevel up, insert intralesionally, inject ~0.2mL, "wiggle" while you inject

7. Massage area post injection do disperse Kenalog

8. Apply e-mycin ung along injection site

9. Rx e-mycin ung for bid x 1 week

10. RTC varies, usually 2 weeks to determine if second injection required

Describe the steps of chalazion incision and curettage.

1. Wear gloves, topical proparacaine, alcohol swab/prep injection site

2. 27 gauge

3. Draw up ~0.2-0.3mL (shake bottle!)

4. Apply clamp and evert lid

5. Sterile surgical blade to create ~3mm vertical incision

6. Stay 2mm away from the lid margin (prevent notching)

7. Will see release of granulomatous material

8. Total excision: grasp capsule with toothed forceps and 9. detach capsule with surgical scissors

(optional kenaglog injection)

10. Apply E-mycin ung, remove clamp, apply pressure patch