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Meibomian Cyst

A meibomian cyst, commonly referred to as chalazion, is a non-infectious inflammatory disease of the sebaceous glands on the eyelids that presents as an enlarging lump over the course of days or weeks without resolution to topical antimicrobial therapy. Acne rosacea and seborrheic dermatitis increase the risk for meibomian cysts. Blurred vision may be encountered with larger meibomian cysts, while pain is almost always absent. The diagnosis rests on clinical criteria, but because malignant tumors may have an identical clinical presentation, a histopathological examination is advocated.


Presentation

A meibomian cyst (also known as chalazion) arises when the outflow of the meibomian glands in the eyelids is blocked, leading to the accumulation of the secretions produced and the formation of a cyst [1] [2] [3] [4]. It is defined as a benign lipogranulomatous collection that develops from non-infectious causes, which is the crucial feature distinguishing it from a stye, which is formed because of a bacterial infection [4] [5] [6]. The clinical presentation is characterized by the appearance of a painless lump on the eyelid that grows over a period of days or weeks [1] [2]. The lump exhibits a variable degree of tenderness, swelling, and redness (depending on the stage) that often overlaps with the presentation of a stye, but all of the aforementioned signs eventually subside [1] [4]. Both upper and lower eyelids may be the location of a meibomian cyst, which can sometimes appear in multiple sites [4]. In some cases, the cyst may be large enough to induce mechanical ptosis or astigmatism, leading to symptoms such as blurred vision and deficits in the visual field [1] [4]. A cosmetic discomfort is also an important complaint and is often the main reason for a visit to the physician [4]. Several cutaneous disorders have been associated with an increased risk for meibomian cyst formation, including rosacea, seborrheic dermatitis, and blepharitis [1] [4].

Camping
  • […] a human being bombast pompous or pretentious talk or writing man-sized calling for the strength of a man blood cyst a cyst containing blood bomb blast the explosion of a bomb abominate find repugnant Osip Mandelstam Russian poet who died in a prison camp[vocabulary.com]
Skin Atrophy
  • Temporary skin atrophy. Subcutaneous white deposits. (Rarely) rise in intraocular pressure. The most common problem is recurrence of the chalazion.[patient.info]
Blepharitis
  • Blepharitis Blepharitis refers to inflammation of the eyelid margin. Find out about troublesome Blepharitis and recurring Blepharitis.[evidence.nhs.uk]
  • Aetiology Blockage of Meibomian gland duct with retention and stagnation of secretion May occur spontaneously or follow an acute hordeolum (internal) Predisposing factors Chronic blepharitis Rosacea Seborrhoeic dermatitis Pregnancy Diabetes mellitus Symptoms[college-optometrists.org]
  • Associated diseases [ 5 ] Blepharitis Acne rosacea Seborrhoeic dermatitis Management Chalazion Chalazia can resolve spontaneously.[patient.info]
  • You can reduce the irritation by keeping the lid clean and using artificial tears. treating blepharitis. Contact dermatitis is another possible cause of itchy or flaky lids.[knowyourdoctor.com.cy]
Red Eye
  • Possible problems include: · Swelling and bruising are temporary, but in some patients can take longer than normal to recover · The cyst might not disappear or could regrow after the operation · Allergy to the drops or ointment causing a sore red eye[netmums.com]
  • Symptoms include watering of the eye, redness, eye irritation, crusting discharge. Entropion is the inward turning of either lower or upper eyelid, resulting in the eye lashes rubbing against the eye causing pain, redness and irritation.[murdocheye.com.au]
  • If any of the following signs of infection occur, please seek medical advice immediately: Swelling of the skin around the chalazion Redness or discolouration of the area Warmth and tenderness of affected area Fever Acutely sticky, red eye with severe[childrens.health.qld.gov.au]
Withdrawn
  • Keratitis in Children - MEIBO-ROSACEE Recruiting NCT03479853 9 Subconjunctival Injection of Local Anesthetic in Anterior Blepharoptosis Repair Not yet recruiting NCT02959697 Not Applicable 10 Intralesional Tetracycline Injection in the Treatment of Chalazia Withdrawn[malacards.org]
  • […] everlong Mon 21-Dec-09 16:56:58 Message withdrawn at poster's request. This is page 1 of 1 (This thread has 17 messages.)[mumsnet.com]

Workup

With a properly conducted physical examination and a meticulously obtained patient history, the initial diagnosis of a meibomian cyst can be easily made. The typical appearance of a lump on the eyelid without the presence of pain (mainly seen when a stye develops) is a hallmark of this clinical entity. Some patients report ineffective use of topical antimicrobials [1], which points to a non-infectious type of inflammation. Although the physician can clearly visualize the lesion and make a solid diagnosis based on physical findings only [1], some authors recommend further evaluation of the lump through histopathological methods [2] [3] [6]. The primary reason is that several tumors, particularly sebaceous cell carcinoma (carrying a mortality rate of 20% in the absence of an early diagnosis and up to 50% when tumor spreading occurs) have an identical clinical presentation [2] [3] [5]. Disruption of the skin and ulceration are suggested as signs indicative of a malignancy instead of a meibomian cyst [1], but they may not always be present. The identification of a lipogranulomatous content and multinucleated giant cells with an abundant white blood cell infiltrate are main findings on microscopy of meibomian cysts [6]. Noninvasive meibography, designed to evaluate the morphology of the meibomian glands, is a potentially useful procedure to discriminate between a chalazion and a sebaceous cell carcinoma [5].

Treatment

  • Prognosis Up to 50% of chalazia resolve (spontaneously or with conservative treatment) but it is not uncommon for them to recur [ 3 , 7 ] .[patient.info]
  • Prognosis Up to 50% of chalazia resolve (spontaneously or with conservative treatment) but it is not uncommon for them to recur [ 3, 7 ].[patient.info]
  • A prospective randomized treatment study comparing three treatment options for chalazia: triamcinolone acetonide injections, incision and curettage and treatment with hot compresses. Clin Experiment Ophthalmol 2007;35:706-12[pulsetoday.co.uk]
  • Initial Treatment Initial treatment should include: massage through a hot flannel for 30 seconds first thing (at least twice a day) in the morning and last thing at night and any other times that are possible.[valeofyorkccg.nhs.uk]
  • […] of Meibomian Gland Dysfunction Completed NCT01202747 Phase 2, Phase 3 3 Chalazia Treatment Study Recruiting NCT02025023 Phase 3 5-fluorouracil Injection;Triamcinolone Acetonide;Triamcinolone Acetonide/5-fluorouracil mixture 4 Safety and Efficacy Study[malacards.org]

Prognosis

  • Prognosis Up to 50% of chalazia resolve (spontaneously or with conservative treatment) but it is not uncommon for them to recur [ 3, 7 ].[patient.info]
  • Prognosis Up to 50% of chalazia resolve (spontaneously or with conservative treatment) but it is not uncommon for them to recur [ 3 , 7 ] .[patient.info]
  • A chalazion is usually a self-limiting condition with excellent prognosis. However, the patient is instructed to follow regular lid hygiene measures and control of meibomitis. Prognosis Prognosis is excellent. Jerry A. Shields, Carol L. Shields.[emedicine.medscape.com]

Etiology

  • However, there may be times when an associated infectious etiology is suspected. If an infection is considered, tetracyclines are the antibiotics of choice.[ncbi.nlm.nih.gov]
  • Etiology: Normally, sebaceous meibomian glands of the eyelid produce an oily substance (meibum) that forms the hydrophobic lipid layer of the tear film.[pedclerk.bsd.uchicago.edu]
  • Etiology Chalazia occur after gland blockage, which can be associated with the following: Poor lid hygiene (the precise causal role has not yet been established) Acne rosacea High blood lipid concentrations (possible risk from increased blockage of sebaceous[emedicine.medscape.com]

Epidemiology

  • Epidemiology [ 1 , 4 ] Chalazia are the most common of all lid lumps. They can occur at any age.[patient.info]
  • Epidemiology [ 1, 4 ] Chalazia are the most common of all lid lumps. They can occur at any age.[patient.info]
  • Key points Description Benign granuloma of oil-producing gland of the eyelid Cause Blockage of gland duct by thick oil or keratin causes gland rupture and lid inflammation Epidemiology Common lid lesion associated with blepharitis at any age Clinical[pulsetoday.co.uk]
  • Meanwhile, recent epidemiological survey showed MGD is a major cause of dry eye. In the MGD clinic, we thoroughly examine both subjective symptoms and objective findings for accurate diagnosis.[ophthal.med.keio.ac.jp]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Chalazia form when lipid breakdown products, possibly from bacterial enzymes or retained sebaceous secretions, leak into surrounding tissue and incite a granulomatous inflammatory response. [2].[emedicine.medscape.com]

Prevention

  • How to prevent chalazion cysts The best way to prevent the development of chalazion cysts is to keep your eyelids clean and free of irritants. Wash your hands often to prevent dirt from being transferred to your eyelid when you rub your eyes.[belmarrahealth.com]
  • […] understand that you are thoroughly tired of battling with this condition but it seems as if your doctors have been doing everything according to the book to treat this and if you keep on getting repeated infections, you may need to use tetracyclines preventatively[health24.com]

References

Article

  1. Arbabi EM, Kelly RJ, Carrim ZI. Chalazion. BMJ. 2010;341:c4044.
  2. Ozdal PC, Codère F, Callejo S, Caissie AL, Burnier MN. Accuracy of the clinical diagnosis of chalazion. Eye (Lond). 2004;18(2):135-138.
  3. Al-Mujaini A, Sabt B, Al-Hadabi I. It is not chalazion. Oman J Ophthalmol. 2013;6(1):63-69.
  4. Gilchrist H, Lee G. Management of chalazia in general practice. Aust Fam Physician. 2009 May;38(5):311-314.
  5. Nemoto Y, Arita R, Mizota A, Sasajima Y. Differentiation between chalazion and sebaceous carcinoma by noninvasive meibography. Clin Ophthalmol. 2014;8:1869-1875.
  6. Ahuja S, Rao VA, Kumar P, Rajesh N, Srinivasan R. Sebaceoma of the Conjunctiva Presenting as a Chalazion. Indian J Dermatol. 2014;59(5):521-522.

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Last updated: 2019-07-11 22:05