Effectiveness of Intralesional Triamcinolone Acetonide Injection in Uncomplicated Chalazion: A Prospective Observational Study at a Tertiary Care Hospital of Eastern India

Abstract

Introduction: A chalazion is a self-limiting lipo-granuloma of the eyelid. Patients typically present with lid swelling, pain, and symptoms of local irritation. Larger lesions may cause disfigurement, depigmentation, ptosis, amblyopia, and secondary exotropia. For persistent lesions, Triamcinolone Acetonide (TA) injections and Incision and Curettage (I&C) are the most common procedures, with reported success rates of 87-89% and 62-92%, respectively, in previous studies. While I&C offers a more consistent success rate, intralesional steroid injection has potential advantages, including not requiring an additional anaesthetic injection, reduced bleeding, and lower risk of scarring. It can be performed in the Outpatient Department (OPD) and can be used for multiple chalazia. Despite the array of options for managing chalazion, the choice is not always clear, and there is a need for a method to clinically assess chalazion consistency before initiating invasive surgical treatment. Aim: To determine the efficacy of administering intralesional TA injection in patients with persistent uncomplicated chalazion. Materials and Methods: This prospective observational study was conducted in the Ophthalmology Outpatient Department (OPD) of R.G. Kar Medical College, Kolkata, India, over a period of two years, from April 2021 to March 2023. A total of 138 patients with uncomplicated chalazion measuring 2 mm to 10 mm were included. A volume of 0.05-0.15 mL of a 40 mg/mL aqueous suspension containing 2-6 mg of TA was injected into the center of the chalazion via the transconjunctival or transcutaneous route after administering topical anaesthesia (proparacaine 0.5% drops). The injection was repeated in the same dosage if the chalazion did not reduce by half its original size after the first injection, with a maximum of three additional repeat injections at two-week intervals. All data were tabulated, and statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) software version 24.0 (IL, USA). The Chi-square test was used to assess size changes after TA injection, and p-values less than 0.05 were considered significant. Results: A total of 47 (34.1%) chalazia completely resolved within two weeks, and 70 (50.7%) showed a reduction in size at 2-4 weeks following the first dose of TA injection. After six weeks, a total of 111 (80.4%) patients showed complete resolution. There was recurrence in 9 (6.5%) patients, and 18 (13.1%) patients showed treatment failure. No major complications were noted in 130 (94.2%) patients; depigmentation was observed in 4 (2.9%) patients, an uneven scar was noted in 1 (0.7%) patient, and eyelid fat atrophy was seen in 3 (2.2%) patients after the first dose of injection. Conclusion: Intralesional injection of TA is a simple, fast, and less painful procedure for uncomplicated chalazia measuring 2 mm to 10 mm, with no major complications observed.

Keywords

• complications
• efficacy
• eyelid
• lipo-granuloma