• Letters

    Thoughts From Your Colleagues

    Download PDF

    Comments on Chalazion

    I enjoyed your thorough review of chalazion (“Chalazion Management: Evidence and Questions,” Pearls, September). After more than 25 years as an ophthalmic plastic subspecialist, I have a few empiric comments.

    1. Every “chalazion” I have seen that ultimately proved to be a neoplasm was atypical in appearance (and I often suspected basal cell carcinoma or the like upon initial presentation). Routine pathology on routine chalazia is the one lesion, in my practice, that has had a 0% yield (over the course of many hundreds of cases, over many years). As the authors point out, biopsy/pathology is very important for any “suspicious” chalazion.
    2. The authors quote an approximately 87% success rate for chalazia incision and curettage (I&C). In a referral practice, the large percentage of chalazia I&C “failures” I see are due to residual inflammatory material (arising within the tarsal plate/meibomian glands) that has migrated anteriorly into the subcutaneous tissues. When a patient presents primarily with this type of multiplanar chalazion, I routinely combine an internal incision and drainage (I&D) with a small external horizontally oriented pretarsal skin incision to perform a concomitant external I&D. These combined incisions all heal very well and yield a success rate of over 87%.
    3. Some chalazia are largely soft and gelatinous, while others are more than 75% thick and solid. In these latter cases, I routinely perform (with sharp Westcott scissors) careful excision of much of the chalazion pseudocapsule. This is a common finding in many chronic nonresolving chalazia (i.e., present for greater than 6 months’ duration), such that a very thick, exuberant pseudocapsule is quite typical. I do not usually use corticosteroid injections, and generally reserve this for chronic, red lid margin inflammation and chronic granulation tissue that would be difficult (or harmful) to excise.

    I congratulate the authors on comprehensively summarizing the topic of chalazion, and respectfully submit my additional thoughts on this topic.

    Myron Tanenbaum, MD, FACS

    WRITE TO US Send your letters of 150 words or fewer to us at EyeNet Magazine, AAO, 655 Beach Street, San Francisco, CA 94109; e-mail eyenet@aao.org; or fax 415-561-8575. (EyeNet reserves the right to edit letters.)