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RCMC Journal Volume-1, No-1, July 2011 Efficacy of Intralesional Triamcinolone Acetonide Injection
in the Management of Chalazion.
Md. Akhtaruzzaman,1Md. Ataur Rahman2 Abstract :
Purpose: To evaluate the safety and efficacy of intralesional triamcinolone acetonide injection in the
treatment of Chalazia. Study Design: Prospective interventional study. Material and methods: 96
Patients presenting with Chalazia, with a range of age 12 years and above, treated at the Dept. of
Ophthalmology, BSMMU, Dhaka from July 2008 to June 2009 were included. Study population were
divided into two groups on patients choice method. Group–A ( study group) consists of 54 chalazion
patients who were took triamcinolone acetonide injection and in Group–B (control group) where 42
chalazion patients underwent incision & curettage procedure. Data regarding: Lesion size, lesion
regression or recurrence and complete ophthalmic examination were recorded at the time of injection and
subsequent follow-up. Success was defined as the disappearance of or decrease in size of lesion to 1mm
in diameter or less after 1 month of treatment. Results: Success rate was 88% in Group –A and 92.5%
in Group-B. There was no significant difference observed in two groups. Conclusion: Triamcinolone
injection is an effective treatment in Chalazia, achieving lesion regression. Most cases resolve with 1
injection. It may be considered as a first treatment in cases when diagnosis is straightforward. It is a
safe treatment and cost is accessible.
Key word: Chalazion, Triamcinolone Acetoide
RCMCJ 2011; 1(1): 19-24
Introduction
refractive error.3Cosmetically they can be meaning hailstone.1 Chalazion is a chronic inflammatory granulomatous infiltration of conjunctivitis or cellulitus.4 Patients are meibomian glands caused by the blockage of usually initially advised to apply hot meibomian gland orifices and stagnation of compresses to the cyst with a wet flannel to sebaceous secretion.2 The granuloma contains encourage it to spontaneously drain. Previous studies have found a 25-50% resolution rate epitheloid and giant cells, neutrophils, with this conservative treatment.5,6 Persistent eosinophils and lymphocytes. The condition lesions may be treated through different affects almost people of all ages. A chalazion treatment options. These include incision and presents as a mass on the eyelid, causing acetonide 0.2 ml (40 mg/ml), injected through Larger-sized chalazia may cause ptosis and the conjunctiva, in the lesion with a tuberculin syringe.7 In the late 1970’s, treatment with described.8 Since then, there have been a few 2. Registrar, Dept. of Ophthalmology, Rangpur investigating the efficacy, simplicity and Medical College Hospital.
Address of Correspondence: *
safety of intralesional triamcinolone acetonide email: [email protected]
(TA) in the treatment of chalazion and in RCMC Journal Volume-1, No-1, July 2011 from the study. Informed consent was taken corticosteroid injection and surgical treatment from the patients and a proforma was used to of chalazia. But there are no local studies record data regarding lesion size, duration of available to compare the treatment outcomes the lesion, history of onset, whether the lesion of intralesional triamcinolone acetonide injection in primary and recurrent chalazia. recruitment of the patients. Patients were reported following transcutaneous injections but adverse effects are minimized through treatment procedure. Group- A (Triamcinolone trans-conjunctival injection.9 In addition Acetonide injection) was study group and Group-B ( Surgical) was control group. Group –A consists of 54 patients (4 patient dropped injection of triamcinolone acetonide into the out) and Group-B consists of 42 patients (2 chalazion.10 Chalazion is a common eye lid patient dropped out). Patients were also disease. Incision & curettage is the traditional subgroup according to size of lesion and technique and relatively costly, requiring pad and bandage for some hours. On the other hand intralesional triamcinolone acetonide is reduction of size of chalazion. The patient relatively less invasive method which is very was reviewed after 2 weeks. The size of the lesion was again measured at longest axis in bandage, hence not curtailing the working mm. If the lesion had reduced by half of its original size at the two weeks stage, the Several studies7,9 have shown that intralesional appointment after one month and, if all was successfully treat the chalazion. So studies are well at this stage or decrease in size of necessary to observe the efficacy of this chalazion to 1mm in diameter the patient was intervention in the management of chalazion in comparison to traditional incision and repeated if the chalazion had not reduced by half of its original size. Success was defined as the disappearance of or decrease in size to Materials & Methods:
1mm in diameter or less within after one This prospective interventional comparative months of initial treatment. If a lesion study was carried out in the Department of recurred or regressed minimally (<50%), further injections were administered. Patients Medical University, Dhaka over a period of who did not respond to two injections after one one year from july 2008 to june 2009. 96 month were referred for surgical procedure. patients of both male & female patients, age 12 years and above, primary and recurrent Technique of intralesional triamcinolone
chalazion patients were included in this study. acetonide injection:
6 patient were dropped out during follow up. The triamcinolone acetonide injection 40 The painful chalazion, chalazion suspicious to mg/ml was diluted with 3 ml 2% lignocaine injection to form 10 mg /ml concentration diseases and age below 12 years were excluded Then 1 ml triamcinolone acetonide was taken RCMC Journal Volume-1, No-1, July 2011 by 1 ml insulin syringe with 27 gauge needle. The conjunctiva was anaesthetized with 0.4% oxybuprocaine drops. The skin of the eyelids Table-I and II shows the success rate of triamcinolone acetonide injection (Group A) povidone iodine and draping of the treated and incision & curettage (Group B) group in eye was done meticulously. The eyelid was treating chalazion in respect of size of the everted without use of chalazion clamp and lesion respectively. No significant difference needle was passed transconjunctivally into the (p>0.05) was observed within both group chalazion in such a way that inadvertent perforation of globe could not occur, even if the needle was passed too deeply and during Success rate of Intralesional triamcinolone procedure lid guard was used. A 27 gauge needle on 1ml insulin syringe was used to acetonide injection in treating the chalazion according to size of the lesion ( Group -A ) triamcinolone acetonide transconjunctivally into the chalazion. The amount of injection depends on the size of the lesion or resistance felt on the syringe plunger (Fig-I). In this procedure a total 54 patients with chalazia were treated with triamcinolone acetonide injection. Care was taken not rupture the wall Table: II
of the chlazion. If the wall of the chlazion Success rate of Incision and curettage in ruptured, the case was excluded from the treating chalazion in respect of size of the study. The eye was not padded after procedure but was given chloramphenicol eye ointment to apply to the treated eye three times daily for 5 days and was instructed to apply gentle digital massage over the chalazion for 5 minutes after each ointment application.
injection and incision & curettage according to duration of the lesion were shown in Table III and IV. The result was not significant Table: III
Response to triamcinolone acetonide injection according to chronicity of the lesion in Group-A Fig.I:Procedure of injection
RCMC Journal Volume-1, No-1, July 2011 Table: IV
Table-VIII
Response to incision & curettage according to Complications of intralesional triamcinolone versus incision & curettage after one month follow up.
Complications Injection group (50) Incision & curettage Table V & VI shows the outcome according to Discussion
follow up in triamcenolone acetonide injection treated patient (Group-A) and incision & curettage group (Group-B) respectively.
composed of corticosteroid sensitive histocytes, multinucleated giant cells, Result of triamcenolone injection group after corticosteroids has the desirable effect of suppressing additional inflammatory cells and impending chronic fibrosis and scar formation, which typically appear as a small, firm, non tender aft er resolution of the acute chalazion.
Table: VI
Result of incision & curettage group after first In our study, no significant differences were observed within triamcinolone acetonide injection (Group A) and incision & curettage (Group B) group regarding success rate in respect to different size of the lesion. These findings are comparable with the study of HO Table VII Shows the comparison of success injection and incision & curettage according to results was not significant (p >0.05).
duration of the lesion were not significant Table: VII
(p>0.05) Similar finding are observed in the Comparison of success rate between injection group ( Group-A) & operation group (Group-B) population 66% lesion response with the 1st dose of injection and 20% lesion response with the 2nd dose of injection whereas 89.18% lesion response with the first procedure and procedure in incision & curettage group. This triamcinolone acetonide injection versus incision study result is also similar with the watson & & curettage groupwere shown in Table-VIII RCMC Journal Volume-1, No-1, July 2011 proportion of cases (14%) required surgical acetonide injection group were 86% and in the incision & curettage group were 92.5%. There triamcinolone acetonide is quick, safe, cheap was no statistically significant difference between two groups of treatment. This study is corresponds with that of Goawalla and lee Conclusion
During one month follow up period there was depigmentation of the lid skin which is There is no obvious ideal treatment for all yellowish white in colour observed in two cases of chalazion. However the surgery is more time consuming and requires the use of operating room, sterile instrument etc. Steroid suspension form and partly due to local side injection can be applied in treating children, effect of steroid. In incision & curettage group multiple chalazion where surgical treatment is there were no such types of complication not feasible & patients who are afraid of observed during one month follow up period. undergoing surgery. It is simple and cheap and This study is comparable with that Rahman injection may be an effective alternative to the Analysis of outcome evaluation in this study shows that intralesional triamcinolone acetonide injection is effective in resolving References
chalazia as incision & curettage irrespective of 1.
ages and sexes of the patients and size or chronicity of chalazion, though 20% patients Concepts, 8th ed. St. Louis: Mosby; 1996: with chalazia needs second injection and in incision & curettage group 10.81% lesion Sivasane S, Shah D. Proceedings of annual conferences of al india ophthalmological society are published as year books. AIOS conventional surgery are that it is simple and cheap, minimal bleeding, eliminate the risk of damaging the eyelid structures, requires no triamcenolone in chalazion: a reason to relax special instrument and convenient for patients and doctors. Paching is not needed. Multiple URL:http:/ www.aios.org/proceed08/papers/ind chalazia in the eyelids of both side can be treated in same sitting. This type of treatment 3.
is specially suitable for chalazion near the medial canthus to avoid damage to lacrimal The disadvantage of this procedure is that for orbital cellulitis. Int ophthalmol clin. 20% cases required second injection and small RCMC Journal Volume-1, No-1, July 2011 resolution. Br Med J. 1983; 287: 1595.
corticosteroid therapy of chalazia. Am J 10. Newrock J, Swietliczko I, Newrocka Z. accidental injection of depot steroids into between intralesional steroid therapy and

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