Eyeworld

N EWS 22 | EYEWORLD | MAY 2019 Steven Safran, MD, uses the Ellman. "You have total control of your incision size, less bleeding, and can make multiple entries with the tip looking for a pocket. Then you can use the same tip to cauterize," he said. The fourth question was, "Do you use a chalazion clamp for adults, and if so what style?" Respondents said: continued from page 21 Round normal size 74% D-shaped normal size 15% Round pediatric size 8% D-shaped pediatric 2% No clamp 2% Yes 49% No 51% Yes 2% No 98% Yes 3% No 97% Yes 41% No 59% Yes 61% No 39% Yes 3% No 97% The chalazion clamp offers stabilization, hemostasis, pressure to encourage egress of material, and the plate protects the other side where the outer lamella of the lid and the globe are. The fifth question was, "Do you sometimes use intralesional steroid (such as triamcinolone acetonide) instead of surgery?" Some chalazia are better addressed by an intralesional steroid, which can suppress inflammation and be curative. I use intralesional steroid by itself in cases of a marginal chalazi- on, one in the vicinity of a canaliculus, a diffuse one, very small ones, or when there are more than two. I have used it in patients who have an important event coming and prefer not to endure the worse bruising and swelling of inci- sional surgery but want to do something. The sixth question was, "Do you some- times use intralesional 5-FU instead of surgery? The seventh question was, "Do you some- times use intralesional steroid plus 5-FU instead of surgery?" The eighth question was, "Do you some- times augment surgery with an intralesional steroid or 5-FU injection?" I augment surgery with intralesional steroid for cases where there is considerable inflamma- tion or a disappointing yield of lipogranuloma- tous material. The ninth question was, "Do you prescribe topical drops after surgery?" Being an inflammatory rather than infec- tious condition I normally do not use postop- erative drops, but since an incision is made, an argument could be made for prophylaxis with antibiotic. I never use postop drops and have never had a problem. The tenth question was, "If the contents appear to be the typical lipogranulomatous material, do you always send it for pathologic examination anyway to make sure it's benign?" One reason not to send a specimen with low chance of cancer is the cost. Reasons to consider sending a specimen would be recurrent chalazion, unusual features such as a yellow dis- charge, notable firmness, no material presenting from the incision, severe distortion of tissue, older patient, and destruction of lashes. I hope this article has helped you reflect on how to manage this common condition and can lift some of the boredom classically associated with it. "[Patients] want something done and are anxious about surgery. Anything worth doing is worth doing right, with maximum comfort and cure rate."

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