A rationale for therapeutic decision-making in chalazia.

BACKGROUND

Cytologically, a chalazion may be either a mixed-cell or a suppurating granuloma. Treatment includes incision & curettage or intralesional steroid injection. The choice of treatment is based on clinical experience.

OBJECTIVE

To determine whether the cytological type of chalazion has any bearing on its response to treatment.

MATERIALS AND METHODS

Prospective study of 62 clinically suspected cases of chalazia subjected to fine-needle aspiration cytology followed by either incision & curettage or intralesional steroid injection. The outcome measure was the size of the residual lesion at one week and one month post-intervention. The relationship between cytology and age, duration, size of lesion, type of treatment and response was analyzed by means of Student's t-test, the chi-square test and discriminant analysis.

RESULTS

Thirty-five (56.5%) patients underwent incision & curettage while 27 (43.5%) received intralesional steroid injections. Cytology revealed mixed-cell granuloma in 41 (66.1%) and suppurating granuloma in 21 (33.9%) of the lesions. Patients aged > or = 35.1 years, lesions with duration > or = 8.5 months, and lesion sizes > or = 11.4 mm (correctly classified in 66.1%, 66.7% and 71.0% of the cases, respectively) were likely to have/be suppurating granulomas. Mixed-cell granulomas responded equally well to the two therapeutic modalities, while suppurating granulomas responded significantly better to incision & curettage (p = 0.008).

CONCLUSION

Mixed-cell granulomas may be treated by either of the two therapeutic modalities. However, suppurating granulomas should be treated by incision & curettage. Incision & curettage should also be the procedure of choice in patients > or = 35.1 years of age, lesions with duration > or = 8.5 months, and lesions > or = 11.4 mm in size.