Chalazion

CHALAZION (from Greek chalaza- hail, hailstone), a chronic disease of the Meibomian glands, in which a rather firm tumor forms in the cartilage of the eyelid. Arlt was the first to accurately indicate the localization of the pathological process in Ch. in the thickness of the tarsal cartilage in connection with the Meibomian gland. Typically developing slowly, Ch. sometimes remains for a long time in the same position. Often, starting as a small nodule, Ch. gradually increases in size, and its magnitude varies from a pinhead to a large pea. In some cases, the development of Ch. is accompanied by minor inflammatory phenomena (slight limited redness of the eyelid skin and pain), more often the latter are completely absent, and the patient seeks medical help only when the tumor becomes noticeable on the outer surface of the eyelid in the form of a nodule of larger or smaller size (fig. 1). At the site of Ch., the skin is mobile, and the tumor itself is closely connected to the cartilage. Occupying the entire thickness of the cartilage, Ch. reaches its posterior surface, where it shines through the conjunctiva as a reddish-yellowish spot. As a result of softening of the contents of Ch., cavities filled with mucous, sticky, turbid fluid appear in it. A long-existing Ch. ultimately represents a cyst with a thick wall and mucous contents. Sometimes suppuration of Ch. (chalazion inflammatum) may occur with subsequent spontaneous opening, through which a sticky, turbid fluid is discharged, and mushroom-like growths of granulations form on the conjunctiva. According to some, Ch. is an adenitis, periadenitis, retention cyst of the Meibomian gland. According to others, Ch. is a special chronic inflammation of the Meibomian gland, caused by a special microorganism different from pyogenic cocci (Fuchs). The pathological changes in Ch. initially consist of proliferation of the epithelium of the acini of the Meibomian gland and round-small-cell infiltration of the cartilage tissue. The subsequent necrosis of the gland acini and cartilage tissue is accompanied by the formation of granulations, around which a connective tissue capsule develops. Among the elements of infiltration, giant cells are also observed, the presence of which gave many authors reason to consider Ch. a manifestation of tuberculosis, however, numerous experiments with inoculations showed that there are no tubercle bacilli in Ch. Giant cells in Ch. appear, similar to how they appear around any foreign bodies or around difficult-to-resorb pathological products. Ch. proceeds benignly and no caseous degeneration is observed in it. Ch. can exist singly. Sometimes numerous Ch. are observed, located on one or both eyelids. Adults suffer from Ch. more often than children. Some individuals show a special tendency to the disease Ch., which moreover often recurs in them. Being essentially a relatively harmless condition, Ch. causes disfigurement of the eyelid, and for cosmetic reasons, it becomes necessary to take certain therapeutic measures. Sometimes to this disfigurement is added irritation of the eyeball, when it is in constant contact with the uneven, granulation-covered conjunctiva. The diagnosis of Ch. is established quite easily on the basis of the above signs. Only in some cases is it not excluded to take an atypical form of a cancerous tumor originating from the Meibomian gland for an ulcerated Ch. The question is resolved by microscopic examination (Sourdille, Dor, Smirnov, Levitskaia, etc.). Treatment. Small Ch. sometimes resorb under the influence of massage (better rubbing in) yellow mercury ointment. Ch. that do not resorb are subject to excision together with the capsule if possible (fig. 2). If Ch. lies close to the skin surface, its excision is best done through a horizontal skin incision. To devascularize the operative field and protect the eyeball, the eyelid is clamped in a Demar's pointed forceps (see Forceps, fig. 52). If Ch. is located closer to the conjunctiva, then its excision is best done through a vertical incision of the conjunctiva, also using the help of Demar's forceps in this case. If the integrity of the capsule is violated, the remnants of Ch. must be carefully removed, the bed of Ch. must be curetted with a sharp spoon and treated with tincture of iodine.

HAGEDORN-JENSEN METHOD, see Blood.