A Study of Management of Primary Chalazion in Adults by Intralesional Injection of Triamcinolone Acetonide

Introduction A chalazion is a common non-effective granuloma of the meibomian glands of eyelids. They are commonly found on the tarsal conjunctival surface and the eyelid margins. It may be ignored by the patients until it reaches a considerable size. Recently the use of intralesional corticosteroids has shown promising results. We in the present study tried to evaluate the outcomes of intralesional triamcinolone acetonide injection in the management of Chalazion. Methods The current study was carried on Patients with chalazion attending Ophthalmology OPD of Rajiv Gandhi Institute of Medical Sciences, [RIMS], Adilabad. Successive patients with small multiple marginal chalazia were included. Patients were selected based on the amenability of treatment with intralesional triamcinolone acetonide injections. A chalazion is a common non-infective granuloma of the meibomian glands of eyelids. They are commonly found on the tarsal conjunctival surface and the eyelid margins. It may be ignored by the patients until it reaches a considerable size. Recently the use of intralesional corticosteroids has shown promising results. We in the present study tried to evaluate the outcomes of intralesional triamcinolone acetonide injection in the management of Chalazion. Results Group I with very small-sized chalazia< 5 mm out of n=22 included in Group I resolution after one week following treatment was found in 72.72%. Resolution following repeated injection after one week was found in 18.18%. In group II (chalazia size 5-7 mm) out of n=28 cases, 46.24% resolved after first injection and 39.28% cases resolved after the second injection and no resolution was found in 14.28% cases after one month. Conclusion Patients with small chalazia who are not amenable to incision and curettage intralesional triamcinolone acetonide injection appear to be a better option. Intralesional triamcinolone acetonide injections were found to be effective in resolving acute and sub-acute chalazia of soft to firm consistency irrespective of their duration.

Review of the Literature on Existing Management of Dry Eye Disease

Dry eye disease (DED) is a multifactorial disease in which the tear film’s homeostasis is lost, along with other ocular symptoms such as tear film instability and high osmolarity, neurosensory abnormalities, and ocular surface inflammation and damage. DED is a condition of lacrimal apparatus which is responsible for tear production. The tear film is a mixture of mucin, aqueous (water and solutes like NacI, sugar, urea, proteins,), lipids secreted by goblet cells, lacrimal glands, and meibomian glands, respectively. It keeps the eye moist, provides oxygen to the cornea, and has antibacterial properties. The lipid layer prevents the evaporation of the aqueous. DED is categorized into (i)Aqueous-tear deficiency, characterized by a deficiency of lacrimal glands to secrete tears, (ii)Evaporative DED, associated with increased tear loss by evaporation because there is a deficiency of the meibomian glands. The mechanism of DED might be loss of tear through evaporation or insufficient aqueous production or a combination of the two. DED is a widespread eye problem, which is often left untreated. It causes irritation, itching, dryness, foreign body sensation, and discomfort; severe case causes conjunctival congestion, keratinization, erosion of the corneal epithelium, and plaque formation. If left Univision- threatening vision-threatening, leading to complications like corneal ulceration and perforation. Various clinical tests are used to diose DED, including tear breakup time, tear osmolarity, Schirmer test, Rose Bengal staining, and expression of inflammatory markers. There is no cure for DED at present. The following modalities are used for its treatment: use of punctual and canalicular plugs, artificial tear products like polyethylene glycol/propylene glycol with guar HP, consuming food rich in omega-three fatty acids, antioxidants zeaxanthin, and lutein, Use of anti-inflammatory drugs, mucolytics, secretagogues. Reducing or avoiding mild risk factors like prolonged reading, prolonged use of contact lenses, excessive screen time, etc. Treatment of causative disease. Appropriate management and establishing reasonable patient expectations are necessary to ensure patient satisfaction and adherence to the treatment.

Evaluation of the Clinical Characteristics of Dry Eye Secondary to Different Types of Liver Diseases

PurposeComparing the clinical characteristics of dry eye secondary to primary biliary cholangitis (PBC), drug-induced liver injury (DILI) and viral hepatitis B(HBV) to evaluate the ocular surface damage caused by different types of liver diseases.Methods32 patients with secondary dry eye, included 10 cases of PBC, 10 cases of DILI and 12 cases of HBV. All patients were evaluated by SPEED questionnaire, corneal fluorescein staining(CFS), non-invasive tear breakup time(NIBUT), Schirmer I test(SIt), tear meniscus height test(TMH), the area of meibomian glands dropout(MG dropout) , partial blinking rate(PBR) and lipid layer thickness(LLT).ResultsCompared with DILI and HBV groups, PBC group had a lower SPEED questionnaire score, but the difference was not statistically significant (F=0.83, P=0.45); the CFS score was higher (c2=7.16,P=0.03), the PBR was higher (F=14.34, P=0.00), the SIt was lower (F=4.30,P=0.02), and the differences were statistically significant. The TMH of PBC and DILI groups was significantly lower than HBV group, and the difference was statistically significant (F=4.15, P=0.02). Compared with PBC group, the LLT of DILI group decreased, the difference was statistically significant (P=0.03). The NIBUT of three groups was lower than normal, but there was no statistical difference between groups (Ff=1.35,Pf=0.27;Fa=2.03,Pa=0.14).The area of meibomian glands dropout of three groups had mild to moderate defects, but there was no significant statistical difference between groups (F=0.32, P=0.73).ConclusionsThe PBC group was more prone to aqueous-deficient dry eye. The DILI group was more prone to obstructive meibomian gland dysfunction (MGD).The HBV group was more prone to non-obstructive MGD. The symptoms of dry eye in the PBC group are mild to moderate discomfort, but the degree of corneal damage is higher, indicating that the corneal sensitivity is reduced, which may be related to the high rate of partial blinking.

Autoimmune Epithelitis and Chronic Inflammation in Sjögren’s Syndrome-Related Dry Eye Disease

Autoimmune epithelitis and chronic inflammation are one of the characteristic features of the immune pathogenesis of Sjögren’s syndrome (SS)-related dry eye disease. Autoimmune epithelitis can cause the dysfunction of the excretion of tear fluid and mucin from the lacrimal glands and conjunctival epithelia and meibum from the meibomian glands. The lacrimal gland and conjunctival epithelia express major histocompatibility complex class II or human leukocyte antigen-DR and costimulatory molecules, acting as nonprofessional antigen-presenting cells for T cell and B cell activation in SS. Ocular surface epithelium dysfunction can lead to dry eye disease in SS. Considering the mechanisms underlying SS-related dry eye disease, this review highlights autoimmune epithelitis of the ocular surface, chronic inflammation, and several other molecules in the tear film, cornea, conjunctiva, lacrimal glands, and meibomian glands that represent potential targets in the treatment of SS-related dry eye disease.

Focused ultrasound stimulation on meibomian glands for the treatment of evaporative dry eye

Current treatments for meibomian gland dysfunction have several limitations, creating a necessity for other advanced treatment options. The purpose of this study is to determine the effectiveness of focused ultrasound stimulation for the treatment of dry eye disease caused by meibomian gland dysfunction. An in vivo study of nine Dutch Belted rabbits was conducted with focused ultrasound stimulation of the meibomian glands. A customized line-focused ultrasonic transducer was designed for treatment. Fluorescein imaging, Schirmer’s test, and Lipiview II ocular interferometer were used to quantify outcomes from three aspects: safety, tear production, and lipid layer thickness. Both tear secretion and lipid layer thickness improved following ultrasound treatment. Five to 10 min after the ultrasound treatment, the mean values of lipid layer thickness increased from 55.33 ± 11.15 nm to 95.67 ± 22.77 nm ( p < 0.05), while the mean values measured with the Schirmer’s test increased from 2.0 ± 2.3 to 7.2 ± 4.3 ( p < 0.05). Positive effects lasted more than three weeks. Adverse events such as redness, swelling, and mild burn, occurred in two rabbits in preliminary experiments when the eyelids sustained a temperature higher than 42°C. No serious adverse events were found. The results suggest that ultrasound stimulation of meibomian glands can improve both tear production and lipid secretion. Ultimately, ultrasound stimulation has the potential to be an option for the treatment of evaporative dry eye disease caused by meibomian gland dysfunction.

Sebaceous carcinoma of the eyelid

Sebaceous carcinoma belongs to rare malignant tumors of the eyelids, is characterized by a variety of clinical manifestations and is often disguised as other tumors or inflammatory diseases of the eyelids. The purpose of the work is to analyze the clinical picture and features of the course of sebaceous carcinoma. Material and methods. From January 2015 to December 2020, 6 patients were diagnosed with cancer of the sebaceous gland (5 patients with adenocarcinoma of the meibomian glands, 1 with adenocarcinoma of the Zeiss sebaceous glands). 4 were women and 2 were men aged from 59 to 89 years. Results. From the moment the first symptoms appeared to adequate treatment, 6-12 months passed. According to the 8th revision of the T-classification of malignant tumors of the AJCC eyelids, two patients had T2b, three had T3b, and one patient had T3c stage. A painless thickening of the eyelid cartilage and the eyelid margin was accompanied by the growth of yellowish dense masses on the conjunctiva in two women; the tumor spread to the eyelid skin in one patient. By the time the primary tumor was diagnosed, none of the patients had metastases to regional lymph nodes and hematogenous metastases. Wide excision of the tumor with simultaneous plastic surgery of the eyelid was performed in 4 patients. After excisional biopsy, 3 patients underwent local external beam radiation therapy to the area of the affected eyelid (Total dose 60 Gy.). Orbital exenteration was performed in two patients. The observation period for the patients: 3 months – 49 months. One patient died of a cause unrelated to the tumor. One patient died of metastases of Zeiss glands adenocarcinoma. Relapse of the tumor developed and metastasis to the preauricular lymph node appeared in one patient. Conclusion. Diagnosis of the sebaceous gland cancer of the eyelids is difficult, it is detected late. Ki67 does not depend on the size of the tumor, however, the large size of the tumor is an unfavorable factor in the prognosis of the disease. All patients with cancer of the sebaceous gland after treatment need to be followed up for at least 5 years with whole body PET/CT once a year. Key words: sebaceous carcinoma of the eyelids, adenocarcinoma of the meibomian glands, adenocarcinoma of the Zeiss sebaceous glands.