Subjects
From August 2017 to August 2018, 71 patients (82 eyelids) who were cured of a chalazion were enrolled in the Hankou Aier Eye Hospital. Including 28 patients (28 eyelids) with conservative treatment and 43 patients (54 eyelids) with surgery. The inclusion criteria were as follows: (a) patients with primary chalazion and a single chalazion on one eyelid; (b) patients who can cooperate examination and received local anaesthesia during surgery; and (c) patients without any other treatment before. The exclusion criteria were as follows: (i) patients who accepted both conservative treatment and surgery during the study (patients who failed to conservative treatment and then accepted surgery); (ii) patients who had a local anaesthetic drug allergy history; and (iii) patients with concurrent eyelid infection combine pain (hordeolum, cellulitis or conjunctivitis).
Patients were treated with conservative treatment in one of the following cases: (a) chalazion duration from patient complaint less than 2 months; (b) the horizontal width of chalazion was less than 5mm. Given the difficulty in assessing the total volume of each chalazion, horizontal width of each chalazion was used to represent this value; and (c) patients refused surgery. Otherwise, patients were treated with surgery (incision and curettage). Patients were considered cured when the chalazion complete resoluted.
Because there was no clear standard for the decision of chalazion treatment now, the treatment strategy depended on the clinical experience and past studies.7-9
Ethics statement
This study was approved by the Ethics Committee of Hankou Aier Eye Hospital and followed the tenets of the Declaration of Helsinki. Written informed consent was obtained from all patients.
Examinations
Each patient finished two parts of the clinical examinations before treatment and 1 month after the chalazion complete resolution: meibomian gland function assessment and meibomian gland morphology of the chalazion area. All examinations were conducted by the same observer during the whole process of the study.
Meibomian gland function assessment in the chalazion area
Meibomian gland function evaluation consisted of meibomian gland orifice, meibum quality, and meibomian gland expressibility. All examinations are for the one or several meibomian glands where the chalazion located. The score of these examinations were refered by the 2011 International Workshop on MGD.10 However, because the number of glands invaded by chalazion were different in each patient, the average score was used in this study (the total socres/the number of glands).
Meibomian gland orifice
The meibomian gland orifice condition was assessed on a scale of 0 to 3 : 0, normal; 1, thin blockage; 2, blocked in the orifices; and 3, severe orifices blockage.
Meibum quality
Each meibomian gland where the chalazion located was assessed for quality on a scale of 0 to 3 : 0, clear; 1, cloudy; 2, cloudy with debris (granular); and 3, thick, like toothpaste.
Meibomian gland expressibility
Expressibility in the glands where the chalazion located was assessed on a scale of 0 to 3. The scores were assessed according to the secretion capacity percentage (the number of glands with secretory ability in the corresponding area of chalazion/the total number of glands in the corresponding area) refered to the International MGD Working Group Standard: 0, all glands; 1, 60%-80% glands; 2, 20%-40% glands; and 3, no glands.
Meibomian gland morphology in the chalazion area
Infrared meibomian gland photography
After the eyelids that chalazion located were everted, the morphological picture was taken by noncontact infrared meibography system with the Oculus Keratograph (Oculus GmbH, Wetzlar, Germany) as described previously. ImageJ software was used to calculate the area of the chalazion and the whole area of the tarsal plate which the chalazion located. The proportion of chalazion area =chalazion area/the whole area of the tarsal plate (Fig1).11
In vivo laser scanning confocal microscopy
All patients were examined by using in vivo LSCM (HRT III Corneal Rostock Module; Heidelberg Engineering GmbH, Heidelberg, Germany) as described previously.12 Before each examination, a drop of 0.4% oxybuprocaine eye drop (Santen, Osaka, Japan) was instilled into the conjunctival fornix. After the eyelid that chalazion located in was everted, the center of the Tomo-cap was applanated onto the palpebral conjunctiva of the chalazion area, chalazion area was scanned first, then the non-chalazion area nearby. Two dimensional image sizes measured with 384x384 pixels, with a 400x400mm field of view.
Treatments
The conservative treatment method was as follows: a hot eye mask (Shandong Zhushi Pharmaceutical Group Co., Ltd.) for 10 min in the morning and night, and with one drop of 0.5% levofloxacin eye drop four times a day and ofloxacin eye ointment before bed.
The surgical method were as follows: 1) The chalazion area was infiltrated with about 1 ml 2% lidocaine, after local anaesthesia, the eyelid was everted by using a chalazion clamp. 2) A single vertical incision was made at the point of the chalazion, The contents of the chalazion were removed completely, and the chalazion’s capsule was incised and removed. 3) The eye was bandaged with an eye patch after ofloxacin eye ointment had been applied. The patient was instructed to remove the patch 3 hours later. Eye drop and eye ointment were used according to the method mentioned above.
All operations were performed by the same doctor in the outpatient procedure room on the same day when they were examined. All patients were followed up weekly before the chalazion complete resolution.
Statistical analyses
A paired sample t test was used to compare the meibomian gland function score before and after the chalazion complete resolution. The Wilcoxon rank test was used to compare the proportion of meibomian glands loss at 1 month after chalazion complete resolution and the proportion of the initial chalazion area. P value less than 0.05 was considered statistically significant. The statistical software used was IBM SPSS Statistics Desktop Version 18.0 (IBM Corp, Armonk, NY).