Series of chalazia скачать в хорошем качестве

Series of chalazia

Chalazia come in all shapes and sizes. In general, I try to avoid early incision and drainage (I and D) and encourage conservative therapy. If conservative therapy fails, then I and D is very reasonable to perform. I like to give approximately 1-2 months since the development of the lesion before I and D is performed. This is usually performed from the inside of the eyelid; however, in large external chalazia, a skin incision is often the best to perform. The underlying meibomian gland disease needs to be treated after I and D, or the chalazion will likely recur or another one in a different location will develop. This is Richard Allen at oculosurg.com. This video demonstrates a series of different chalazia that will be treated surgically. The first is a large external chalazion. The meibomian expression is examined and the palpebral conjunctiva is inspected to determine if there is much of a posterior component to the lesion. This lesion will be addressed with an external approach. A chalazion clamp is placed on the eyelid. In this situation, the skin overlying the chalazion is extremely thin and will not be able to be salvaged. Westcott scissors are used to make an incision at the junction of the salvageable skin and the very thin skin around the lesion. I always worry about resecting this amount of skin, but I have been pleased with the way in which the wound heals. Realistically, you cannot address this lesion without sacrificing some of the skin overlying the lesion. The superficial portion of the lesion is removed and the remaining portion of the lesion is then addressed with the chalazion curette. This is performed to the anterior surface of the tarsus. The clamp is removed. No sutures are placed and antibiotic ointment is placed over the wound and an eye pad will be placed. The second chalazion is located on the upper eyelid. I always mark the area on the skin so that when I inject local anesthesia, I do not lose the area of the chalazion. The chalazion clamp is placed. An 11 blade is then used to make an incision through the conjunctiva and tarsus overlying the lesion. The contents are then expressed with cotton-tipped applicators. The curette is then used to remove remaining material. The third lesion is on the lower lid and the clamp is placed on the eyelid followed by incision with the 11 blade. The curette is then used to aggressively remove the contents of the chalazion. I usually do not remove any tarsus unless I am sending a piece for histopathological evaluation. My trainees are often too gentle with the curette – I try to convince them to be more aggressive. The fourth chalazion is also on the lower eyelid. The 11 blade is used to make an incision over the lesion, and the material is expressed. The fifth lesion is on the upper eyelid. The clamp is placed and the eyelid is everted. The incision is made and the contents are expressed. The sixth lesion is on the upper eyelid. The clamp is placed. You can see the expression of the thick, abnormal contents of the adjacent meibomian glands. The 11 blade is used to make an incision and the contents of the lesion are removed. I think you need to be relatively aggressive in using the curette. I like to use a smaller curette rather than a larger one. It is not uncommon to compromise the overlying skin, which does not cause any problems. Some more upper lid chalazia with the same procedure. A lower lid chalazion with copious contents. Histopathological analysis of this material shows lipogranulomatous inflammation. In patients with significant disease, I will inject corticosteroid at the same time as the I and D. This is a 1:1 mixture of 40 mg/ml of triamcinolone and 10 mg/ml of dexamethasone. You do not want this injection to be too superficial as is may leave a white deposit which can take months to resolve. This patient demonstrates the significant meibomian gland disease that is associated with these lesions. It is a reminder that even though you are incising and draining one lesion, this is a process that is affecting all of the meibomian glands on the eyelid, and conservative therapy is necessary after the surgery to try to prevent recurrence. Another patient with upper and lower lid involvement. Again, the significant meibomian gland disease is demonstrated. Another upper eyelid chalazion with expression of the thick contents. (continued in comments)