|Year : 1987 | Volume
| Issue : 4 | Page : 183-185
Intra lesional corticosteroid therapy of chalazia
A Panda, SK Angra
|Date of Web Publication||20-Dec-2008|
Source of Support: None, Conflict of Interest: None
Efficacy of various types of intrachalazion injections of corticosteroids was evaluated. Best results were received by injection of Triamcenolne (80-92.3%). Of the 40 chalazia which received hydrocortisone acetate showed 30-48% total cure rate. But the cases who had dexamethasone therapy did not show encouraging results. The lesions having firm to hard consistency with a chronicity of the process were not suitable cases for intralesional corticosteroid therapy. Cases of recurrent chalazia demand needle aspiration biopsy prior to injection.
Keywords: Chalazia, Hydrocortisone, Dexamethasone, intralesional, Triamcenolone
|How to cite this article:|
Panda A, Angra S K. Intra lesional corticosteroid therapy of chalazia. Indian J Ophthalmol 1987;35:183-5
| Introduction|| |
Surgical extirpation of chalazion is a simple and minor intervention and a commonly employed method for its treatment, but it has its own hazards. Intra/lesional corticosteroid therapy for the same is still simple, cheaper and a convenient procedure without any major complication ,.
The purpose of this study was to evaluate the intralesional injections of three different types of corticosteroid injections to achieve a medical cure of chalazia.
| Materials and Methods|| |
30 patients of age group 15-30 years having 30 chalazia with a mean size of 7.0 mm were treated with intralesional injection of 0.1 - 0.3 ml of corticosteroid injection. The injections of Dexamethasone (10 cases) hydrocortisone acetate (10 cases) and triamcenolone (10 cases) were made. [Table 1]
Another group of 20 patients of age group 8-30 years having 51 chalazia with a mean size of 5 mm also had same amount of injection Hydrocortisone acetate and Triamcinolone respectively. [Table 1] In an additional 6 patients having 10 chalazia, aspiration was tried to establish the diagnosis prior to triamcinolone injection.
In fact we tried needle aspiration with 23 gauge-needle and made a smear to establish the diagnosis by smear cytology. The Triamcenolone was injected by a separate injection with 26 guage needle This procedure was essential to exclude any malignant lesions in elderly group which simulate the pseudo appearance to chalazion. The aspiration was done through a separate route and injection was through a small bore needle to minimise the chance of regurgitation.
Conservative therapy in the form of hot fomentation, local antibiotic ointment and lid massage had been tried and failed to resolve the lesions before intralesional therapy in all cases All the chalazia were devoid of secondary infections In all cases 0.1 to 0.3 ml transcutaneous injections were given with 26 gauge needle without any local anaesthesia Slow massage over the lesion was carried out following the injection and patching of the eye was done for 10-15 minutes only. A follow up examination was performed after 2 weeks The chalazion was regarded as cured, if there was remission of the mass by75% or more, if not then the second injection was given and the cases were followed up again after 2 weeks The patients were asked to present themselves for a follow up once in three months
| Results|| |
Of the 10 chalazia treated with dexamethasone all of them needed second injections after 2 weeks Only one case showed improvement after 4 weeks Of the 10 same chalazia treated with hydrocortisone eight needed the second injection After 4 weeks 7 cases did not show good response.
Of the 10 cases having 35 multiple chalazia and treated with hydrocortisone 15 required second injections, out of which 13 did not show any response after4 weeks Of the 10 cases having 26 similar type of chalazia and treated with triamcenolone only7 required second injections and only two failed to respond to this therapy, other 6 patients having 10 recurrent chalazia of mean size 5 mm & treated with Triamcenolone 2 required second injections out of which only one did not show response after 4 weeks
| Discussion|| |
The procedure of intralesional corticosteroid was considered to be the most acceptable one due to several reasons Firstly it is a quick procedure, There is no need of patching, it is less painful, cheap, and does not require much skill It does not require local anaesthesia and can be performed in children. In cases having multiple chalazia there are no chances of anaesthesia induced oedema with hinders the excision of small deep seated chalazia and lastly the location of chalazia close to the lacrimal punctum can be treated without danger of damage to the lacrimal passages.
Triamcinolone acetonide is an aqueous corticos teroid suspension used for intralesional injection of chalazia with excellent results ,,, . Dexamethasone, a water soluble drug is tried for the same purpose in this study. As the results were not encouraging. Hydrocortisone accetate, a depot preparation was injected in the same amount in similar type of cases as dexamethasone group. The results were also not encouraging. In another group of cases where the patients had the hydrocortisone injection for multiple chalazia a good response was obtained in 48% of lesions Similar type of lesions when treated with Triamcenolone showed a good response in 80% and92% in single and multiple chalazia respectively.
However, the chronic cases with firm to hard consistency did not show the desirable effect.
The results were better when multiple chalazia were subjected to this therapy. It might be due to smaller size of the chalazia in this group.
The mode of action of corticosteroid is not clearly understood It might be to reduce the granulomatous reaction. The effect of the three types of steroid preparation is intricate and is also not well understood We feel that the effect on the chronic inflammatory and granulomatous reactions of these 3 types of drugs is different.
However the procedure has very limited role in infected and chronic cases with hard consistency where surgery is the only answer.
| References|| |
Castress J. Stressborg T. Corticosteroid injection of Chalazia Acta Ophthalmol (KBH) 61 : 93-942,1983.
Palva J, Pohjanpelto PEJ. Intralesional corticosteroid injection for the treatment of chalazia, Acta Ophthalmol. (KBH) 61 : 933-937, 1983.
Pizzarello LID, Kakobiec F.A, Hofeldt AJ, Podolsky MM Silvers DN Intralesional corticosteroid therapy of chalazia Am. J. Ophthalmol. 85: 818-821, 1978.
Watson A P. & David J. Austin Treatment of chala zions with injection of a steroid suspension Br. J. Ophthalmol 68: 833 .