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 -  Incision and curettage of a chalazion Lecture of 0  NEXT»

By definition, chalazion is an enlarged meibomian gland with an obstructed orifice, and containing retained secretory products secondary to chronic inflammation. These usually present as a painless and firm swelling [Figure 1].  Initial treatment for a chalazion in the acute stage is hot compresses for 10-12 minutes daily for a few days, followed in most cases by drainage of the retained material through the gland orifice. However, in chronic cases, the chalazion does not respond to this conservative treatment and must be incised and curetted.

Figure1
Figure 1 - click picture to enlarge
Typical appearance of a chalazion at the
outer aspect of the right upper lid.

The following steps demonstrate incision and curettage of a chalazion:


Step 1:
  After prepping the skin, inject a small volume of Xylocaine with Adrenaline (1:100,000) mixture locally [Figure 2]. Adrenaline minimizes post-operative bleeding. 

Figure2
Figure 2 - click picture to enlarge
Local anesthetic is injected subcutaneously over the mass.


Step 2:
 Localize the lesion on the conjunctival surface before a chalazion clamp of appropriate size is placed [Figure 3].

Figure3
Figure 3 - click picture to enlarge
The chalazion appears as a slightly red, raised lesion
on the conjunctival surface of the tarsus.


Step 3:
 Evert the lid and make sure that the lesion is well centered within the clamp so that the chalazion mass is centered in the open ring of the clamp on the conjunctival surface [Figure 4].

Figure4
Figure 4 - click picture to enlarge
The chalazion clamp is placed with the conjunctival surface
of the chalazion centered in the ring of the clamp.


Step 4:  A vertical incision is made with Bard Parker blade No.15.  The reason for the vertical cut being that the meibomian glands are placed vertically meaning that the vertical cut would not damage the adjacent normal meibomian glands [Figure 5].

Figure5
Figure 5 - click picture to enlarge
Using a No. 15 Bard Parker blade a vertical cut is made over the "lump"
in the center of the ring to gain access to the clogged meibomian gland.

Take care that the incision does not extend within 2 mm of lid margin to prevent post-operative lid margin distortion.


Step 5:  Thick chalazion contents will pour out immediately as the incision is placed at the correct site and correct depth of the mass [Figure 6].

Figure6
Figure 6 - click picture to enlarge
As soon as the blade enters the chalazion, the viscous content spills out.


Step 6:  Then scoop out the contents of the chalazion with the help of largest sized curette possible [Figure 7].

Figure7
Figure 7 - click picture to enlarge
A curette is used to scoop out the contents.


Step 7:  Once assured that cyst has been thoroughly emptied of its contents, remove the clamp [Figure 8]. As the hemostat effect of clamp is gone, it would start bleeding, which should not be of much concern [Figure 9]. Pressure patch the eye well with antibiotic ointment for few hours. Prescribe the antibiotics ointment twice for 3-5 days.

Figure8
Figure 8 - click picture to enlarge
A cotton tip applicator can be used to wipe
away the viscous material ensuring that the
inflammatroy debris is removed completely.

Figure9
Figure 9 - click picture to enlarge
When the clamp is removed hemostasis is lost
and the lid will bleed.  Place antibiotic ointment
in the cul-de-sac and patch the eye with pressure.

In most cases the site will heal completely and the process is complete unless, or until, another chalazion occurs.  Chalazia are usually sporadic and isolated occurrences.  However, in rare instances individuals suffer from multiple, repeated chalazia that require multiple treatments with excision and in some cases prophylactic antibiotics, usually tetracyclines.  Recurrent chalazia should be biopsied to rule out meibomian gland carcinoma.


Dr. Ekta Aggarwal


Reference:

American Academy of Ophthalmology, Basic and Clinical Science Course, External Disease and Cornea, Section 8, 2006-2007, pp. 87-88.


All photos courtesy of: LV Prasad Eye Institute
Used with permission. Not to be reproduced.

 


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