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3SP: Surgery/Injections > Hordeolum/chalazion > Flashcards

Hordeolum/chalazion Flashcards

1
Q

Hordeoulum

A

– Painful and infected lesion
– Associated with blepharitis
– External (zeis) vs internal (meibomian)

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2
Q

Sebaceous cell carcinoma

A

– Often mistaken for recurrent chalazion in the same location
– Associated with madarosis, rapid growth, and acute onset
– High chance of metastasis
• 27% of patients with diagnosed lesion had metastasis

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3
Q

BCC

A

– Most common eyelid malignancy (90%)
• Lower lid, eyelid margin, nasally *** – Ulcerated, raised, pearly borders
– Associated with madarosis
– Rarely metastatic

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4
Q

SCC

A

– 2nd most common eyelid malignancy
– Variable presentations
• Nodular, irregular rolled edges, centralized ulceration
– Associated with madarosis

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5
Q

Molluscum contagiosum

A

– Viral in nature

– Waxy, nodular appearance with central umbilication

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6
Q

Epidermis inclusion cyst

A

– Benign lesion filled with keratin
– Congenital or acquired
– Typically form at a site of prior trauma

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7
Q

Dermatitis and insect bite

A

– Moderate pruritus, edema, and erythema

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8
Q

Documented detailed case history for hordeolum

A

– ROS/Allergies to medications/current medications
– History of cancer? If so, what type? How long ago? Treatment?
– Onset and change/growth over time (if any)?
– Location?
– ABCD (asymmetry, borders, color, diameter)?
– Unusual characteristics like bleeding, ulceration, pain?

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9
Q

Risk assessment for malignancy

A

Send to oculoplastic
• High suspicion of malignancy
• 1+ ABCD
• 1+ unusual characteristics
• Located in medial canthus on lid margin
• Age >55
• Enlarged lymph node on ipsilateral side of lesion

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10
Q

Measurement of chalazion

A

– Length, width, height

– Location

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11
Q

Assessment before chalazion

A

Lymph nodes

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12
Q

Ancillary testing for chalazion

A

Photography

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13
Q

Other things that need done before working on chalazion

A
  • Informed consent
  • Bloodpressure/pulse
  • Visual acuity
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14
Q

Treatment options for chalazion

A

– Conservative/palliative care
– Intralesional steroid injection
– Incision and curettage

Patient must be educated on all options

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15
Q

Conservative palliative care for chalazion

A

– Hot compresses QID x 6 weeks
• Rice & sock, boiled eggs, bruder hydrating masks
– Lid scrubs
– Doxycycline 50mg BID x 30 days

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16
Q

Success of conservative treatment for chalazion

A

50% effective

More time consuming

17
Q

Indications for conservative care for chalazion

A
  • Typically first line treatment
  • <6mm lesion size
  • Lesion located near punctum
  • Patient choice
18
Q

Contraindications for conservative care for chalazion

A

Doxy if patient cannot tolerate/alelergic

19
Q

Risk/complications for conservative care for chalazion

A

Treatment failure

Drug sensitivity

20
Q

Intralesional steroid injection for chalazion

A

– Injection of triamcinolone acetonide (Kenalog) directly into the lesion
– About 25% of the time it requires two injections
• Within 2-6 weeks of one another

21
Q

Success of intralesional steroid injection

A

75-90% effective

22
Q

Indications for intralesional steroid injection

A
  • Failure of conservative method
  • Lesion located near punctum
  • Patient choice
23
Q

Contraindications for intralesional steroid injection

A
  • Steroid if patient cannot tolerate/allergic
  • Darkly pigmented skin color
  • Chronic lesions lasting >6-8 months
24
Q

Risk complications for intralesional steroid injection

A
  • Infection
  • Bleeding
  • Bruising
  • Allergic reaction
  • Depigmentation of lesion
  • No resolution (even with 2 injections)
  • Recurrence
  • Local fat atrophy
  • Vision loss
25
Q

Incision and curettage for chalazion

A

– Surgical intervention with incision and drainage of lesions
– Often after conservative measures do not relieve the chief complaint

26
Q

Success for incision and curretage

A

> 90% effective

27
Q

Indications for incision and curettage

A
  • > 6mm or chronic >6-8 months
  • Conservative or injection treatment did not resolve lesion
  • Patient choice
28
Q

Contraindications for incision and curettage

A
  • Allergy/sensitivity to local anesthetic
  • Unable to hold still
  • Lesion located medially near punctum
29
Q

Risk and complications for incision and curettage

A
  • Infection
  • Bleeding
  • Bruising
  • Allergic reaction to anesthetic
  • Incomplete removal of lesion
  • Scarring
  • Recurrence
  • Lid notching
  • Permanent gland damage
30
Q

Equipment for intralesional steroid injection

A 
– Alcohol and betadine swabs
– Kenalog 10-40mg/mL
– 1cc syringe
– 25 or 27 gauge needle (1/2 inch length)
– Topical anesthetic (4% lidocaine)
– Sterile gauze 4”x4”
– Cotton tip applicators
– Chalazion clamp
– Sharps
31
Q

Pre op for intralesional steroid injection

A

– Prep lesion with alcohol
– Apply lidocaine 4% with wick cell sponge for 30 seconds
– Apply betadine (especially if external injection entry) (wait 3 minutes)

32
Q

Procedure for external intralesional steroid injection

A

• Inject at an angle tangential to the globe
• Stabilize hand onpatient’s face
– Inject 0.2-0.4cc of 10-20mg/mL
– Apply pressure with gauze for 2-3 minutes (blood in tears)
– Apply erythromycin ung in office

33
Q

Intralesional steroid injection for internal chalazion

A

• Evert eyelid with clamp
• Inject at an angle tangential to globe
• Stabilize hand onpatient’s face
– Inject 0.2-0.4cc of 10-20mg/mL
– Apply pressure with gauze for 2-3 minutes (blood in tears)
– Apply erythromycin ung in office

34
Q

Post op for intralesional steroid injection

A

– Rx Erythromycin ung BID x 3-5 days
– Resume hot compresses in 2-3 days
– RTC 2-4 weeks for evaluation of resolution

Reimbursement is $47.86

35
Q

Equipment for incision and curettage

A

– Alcohol and betadine swabs
– 1-3cc syringe
– 27 or 30 gauge needle (1/2 inch length)
– Local anesthetic (Lidocaine 1% w/w/o epinephrine 1:200,000)
– Topical anesthetic (lidocaine 4%)
– Sterile gauze 4”x4”
– Cotton tip applicators & wick cell sponges
– Chalazion clamp and curette
– 11 or 15 blade scalpel
– Erythromycin ung
– Sharps

36
Q

Procedure for incision and curettage

A

– Apply smallest possible chalazion clamp → evert lid
• No slippage but without crushing (PAIN)
– Vertical incision
• Cut away from globe (towards lid margin)
• Stop 2-3mm from lid margin
– Removal capsular contents with curette
– Fibrotic capsule: Excise fibrotic capsule with forceps and
Wescott scissors: cut “X” and snip corners
– Injection intralesional steroid (optional)
– Pressure 3 minutes → hemostasis
– Palpate for completion
– Apply pressure dressing (PRN)

37
Q

Post op for incision and curettage

A

– Rx Erythromycin ung QID x 7 days
– Resume hot compresses in 2-3 days
– RTC 1-4 weeks for evaluation of resolution

3SP: Surgery/Injections (10 decks)

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