Intralesional triamcinolone acetonide injection versus incision and curettage for primary chalazia a prospective, randomized study Guy J. Ben Simon, Nachum Rosen, Mordechai Rosner, Abraham Spierer Goldschleger Eye Institute Am J Ophthalmol 2011; 151:

Chalazia Plugged meibomian gland Chronic lipogranulomatous inflammation Local eye symptoms: irritation and inflammation Cosmetic disfigurement Larger lesions can induce mechanical ptosis corneal astigmatism Self limited in 25-50%

Treatment modalities Eyelid hygiene with warm compresses Antibiotic / steroid ophthalmic ointment Systemic tetracycline chronic blepharitis acne rosacea Surgical treatments steroids injections CO 2 laser excision and curettage total excision BTX-A

Steroid injection Intralesional or sub-cutaneously Reported success and resolution in 50-95% Simple and effective treatment serious adverse effects

Purpose To evaluate the safety and efficacy of intralesional triamcinolone acetonide (TA) injection in primary and recurrent chalazia 147 patients with primary or recurrent chalazia (155 cases)

Results Most of the patients received 1-2 injections Average time to resolution 2.5 weeks Patients who failed to respond 1-2 TA inj. more likely to result in failure to respond to further injections or in surgical excision Patients with blepharitis required on average more injections to resolution 2±1.3 vs. 1.4±1

Results

Conclusions Intralesional TA effective in lesion regression Chalazia that fail to respond to 2 or 3 injections most likely will necessitate surgical excision Should be considered as a first treatment in cases where diagnosis is straightforward

Resolution >80%

Partial resolution (<50%)

Prospective study Intralesional TA (4mg) vs. Incision and curettage for primary chalazia Randomized

Demographics Incision & Curettage TAP N4252 Age(years) GenderMale (ns) Female1729 Duration(months) (ns) LocationRUL1518 RLL (ns) LUL1113 LLL812

ResolutionFailureP Incision & curettage 33 (79%)90.8 (ns) TA42 (81%)10 Success (Chi-Square)

Resolution TA 1 week post RLL TA injection

Resolution TA 2 weeks post LLL TA injection

Resolution TA 1 week post LUL TA injection

Failed TA  I & C A – pre-treatment, B – 1 w post TA, C – 5 w post TA, D – post I & C

Failed I & C  TA 1w post I & C 1w post TA Pre-op.

Incision & Curettage TA Visual acuity Pre-op.20/20 Post-op.20/20 P valuens IOP mmHg Pre-op Post-op P valuens 2 nd outcome measures

TA injection Average time to resolution 5 days Average injections number (92%)- single injection 4 (8%)- two injections Failed cases > older 52 yrs vs. 35 yrs (P=0.001)

TA precipitates 6/52 (11.5%)

Conclusions TA injections as effective as incision & curettage for primary chalazia Most lesions resolve with 1 injection Can be efficiently applied after failed I & C TA precipitates occur in 11% and resolve spontaneously within weeks to months