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OD shares pearls for injecting chalazia
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As a common presentation in the optometry practice, chalazion is a chronic, granulomatous lid lesion often treated with an injectable steroid. However, it might not always be readily apparent whether a chalazion would respond well to an injection.
“When I was a resident, I did hundreds of injections for chalazia,” David K. Talley, OD, said. “And we specifically looked at when you should do a chalazion injection. We came up with the ‘Rule of Six.’”
Talley explained that a chalazion is caused by retained sebaceous materials that weep from the meibomian glands into the adjacent stroma of the tissue.
David K. Talley
“It’s not tender; it’s usually a round nodule,” he said. “I’ve found that up to one-third of these chalazia will resolve with hot compresses or lid scrubs. Two-thirds will require either an intralesional injection to dissolve it or surgical excision and drainage.
“What we found was, if the chalazion is smaller than 6 mm and/or has been there less than 6 months in duration, there is a 60% chance that the lesion will respond to an intralesional steroid injection,” he said. “That’s the Rule of Six.”
Talley said when a patient presents with a bump on the lid that he diagnoses as a chalazion, his next step is to measure it and ask about its duration.
If the chalazion is deemed suitable for injection under the Rule of Six, Talley said he administers 0.1 cc to 0.15 cc of Kenalog-40 (triamcinolone acetonide injection, Bristol-Myers Squibb) per lesion.
He accomplishes this first by administering topical anesthetic. Then he applies the chalazion clamp, a spring-loaded clamp that isolates the bump. If the patient were to accidentally move, he said, the needle would hit the clamp rather than piercing the globe.
He inserts a 27-gauge, half-inch needle directly into the center of the lesion, injecting the contents of the syringe, then removes the needle, then the clamp. Patients are advised to use compresses with massage at bedtime until 2-week follow-up.
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Disclosures: Talley has no relevant financial to disclosures.