Management Of Marginal Chalazia: A Surgical Approach

Rahul Dubey MBBS (Hons) MMed^1,2
Nancy M. Younan MPH, FRANZCO³
Geoff Wilcsek FRANZCO¹
Ian C. Francis FASOPRS, PhD^1,2

¹Prince of Wales Hospital, Sydney, Australia
²University of NSW, Sydney, Australia
³North West Medical Centre Burnie, Tasmania 7919, Australia

Purpose
The management of marginal chalazia is not well established. We describe a technique that recreates near-normal lid margin anatomy, and over many years has been a simple, highly effective technique.

Methods
Case Report
A 60 year old male presented with a typical marginal chalazion present for three months on the left lower lid. Despite lid scrubs with sodium bicarbonate solution, hot compresses, and oculentum hydrocortisone 2% used for two months, the lesion did not resolve. Definitive surgical curettage was carried out.

Technique

1. Using a 30 gauge needle, the surgical site is infiltrated with a proprietary mixture of local anaesthetic and adrenaline, and complete anaesthesia is confirmed.
2. The chalazion clamp is applied, orientated so that the more proximal chalazion can be operated immediately after completion of the marginal element.
3. Using adequate magnification, and a standard chalazion curette, the marginal chalazion is gently curetted in a nasal-to-temporal or temporal-to-nasal direction along the horizontal lid margin.
4. The remainder of the chalazion situated more proximally in the lid is dealt with using the surgeon's customary technique. To avoid lid notching, care must be taken not to connect the main tarsal incision with the marginal defect created following curettage.

Results
Over a 48-surgeon year experience, satisfactory functional and aesthetic results have been evident both immediately and at two weeks following each procedure.

Conclusion
Long term results with the technique described above confirm that lid remodelling results in a final outcome which is almost invariably that of a normal lid.