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Subject: Chalazia Removal
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Tuberculin syringe with a 30-gauge needle
0.05 to 0.2 mL triamcinolone (5 mg/dL)
Proparacaine 1% or tetracaine 0.5%
1% lidocaine without epinephrine
Plastic corneal shield
No. 11 blade
Chronic internal eyelid nodules, often with recurrent nature
Cosmetic deformity from chalazia
Chronic irritation from chalazia
Visual disturbance (induction of astigmatism) from chalazia
Chalazia that have not undergone conservative management
Chalazia associated with chronic unilateral blepharitis or loss of eyelashes due to the possibility of malignancy—especially sebaceous cell carcinoma
Chalazia associated with cicatrizing eye disorders (i.e., ocular cicatricial pemphigoid, Stevens-Johnson syndrome)
Darkly pigmented patients (depigmentation associated with intralesional steroid)
PEARL: Remember to include skin depigmentation and ocular injury in the consent.
PITFALL: The corneal shield may interfere with placement of the chalazion forceps.
PITFALL: This step usually gives incomplete anesthesia, as the tarsus is difficult to completely anesthetize.
PEARL: Use great care in everting the eyelid using these forceps, as disinsertion of the levator may occur with resultant permanent ptosis.
PITFALL: Note that with intralesional steroid injection or incision and curettage, have the patient sit up slowly. Vasovagal reactions are quite common with these procedures.
Recurrence of chalazion
Skin depigmentation (in darkly pigmented individuals)
Infections (uncommon secondary to the rich vascular supply of the lids)
Bleeding (ask the patient about anticoagulant medications or bleeding disorders)—also usually not a significant problem
Ptosis (after use of chalazion forceps)—more common in the elderly
Conjunctival scarring—rare, associated with large incisions and other ocular diseases (i.e., ocular cicatricial pemphigoid).
Central retinal artery occlusion (rare)—associated with periocular steroid injections (including the lids)
Chalazion forceps and curettes may be obtained from Katena Products, Inc., 4 Stewart Court, Denville, NJ 07834 USA (800-225-1195; http://www.katena.com).
Other instruments and supplies may be found in Appendix G.