Can a prolonged chalazion lead to long-term astigmatism?

[nimas11]

Hi,

I'm a 25 year old male with blepharitis. Eight months ago I started getting multiple chalazion on my left upper eyelid which were small and didn't bother me. At the time, I was only cleaning my eyelids once per day. But then around last December of 2016 my upper left eyelid developed another chalazion which was larger (about the size of a m&m) which was causing astigmatism and blurry vision. I went to the Ophthalmologist several times to confirm the diagnosis and was advised to aggressively treat it with warm compresses eight times a day. I was also prescribed tobradex ointment which didn't work and stopped using it. It has been over four months since and the chalazion has reduced in size and the vision has improved slightly but the lesion is still causing some mild blurring (reflection of letters, objects, etc.). My Ophthalmologist knows that because of my blepharitis that I may get more of these in the future so unless my condition doesn't improve, he would be willing to drain it especially if it is still persistent. But I also want to avoid surgery as well because I'm aware that complications may arise even after the chalazion is removed. I have mild dry eyes as a result of blepharitis and knowing that I may be prone to get more of these, I want to avoid exacerbating my eyes further by getting the chalazion surgically removed only to have it return again. My question is will my left eye develop permanent astigmatism if I decide to let the chalazion run its course? I'm still applying warm compresses 3 to 4 times a day from 15-20 minutes at a time followed by massage which helps and the chalazion is now smaller than a pea and is beginning to almost flatten. If I decide to continue treating the lesion this way, how long will the chalazion take to completely resolve and can the astigmatism resolve along with it? This isn't the first time I've had a chalazion that has been causing vision problems.
Two years ago, I had one as well on my right eyelid which took almost a year to resolve on its own. But that was much smaller than this one. I'm willing to treat this chalazion with warm compresses as long as I see results and if it doesn't lead to permanent vision loss. Thanks for reading.

[pleasehelpme911911]

[This is not an answer. I'm just another patient similar to you]
Although the cause is different, your concern and my concern is surprisingly same.. I acquired both eye -0.75 of irregular corneal astigmatism after blepharoplasty surgery 5.5 weeks ago. My ophthalmologist said something is tightening (might be strong adhesion caused by scar tissue inside by eyelid) my cornea so it caused irregular corneal astigmatism. When I saw my corneal topography result, I found that both upper cornea of my eyes were pressed by some external pressure.
It's really annoying that something is pressing my cornea so that it caused irregular astigmatism which cannot be perfectly fixed by eyeglasses. It's really hard to focus on something.. like computer texts or texts in book.
So my concern is if cornea is pressed by something for a long time (probably 1~3years or more), does irregular corneal astigmatism induced by that pressure persistently remains.
So I was really worrying about the same thing.. It's really nice that Dr. Hagan said it's only temporary astigmatism in the above answer.. Really hope thats true. Thank you Dr. Hagan.

[JohnHaganMD]

= answered on your other post

[JohnHaganMD]

No it can cause temporary astigmatism if large but not permanent in adults. Try Ocusoft PLATINUM PLUS lid cleaner and Bruder eye mask (heating pad) to soften oil. If ultra severe Azasite to lids at bedtime (prescription medicine)

[nimas11]

Dr. Hagan,

Thanks for your response. I'm currently using the Ocusoft lid scrubs you've mentioned. As for the Bruder eye mask, I'll definitely look for that at the local pharmacy. I just have a couple more questions and I hope you can address them for me.

How long do you think it will take for the chalazion on my upper lid to completely drain if I continue with the conservative treatment? Will my vision improve as soon as the chalazion resolves?

I'm also aware that a steroid injection into the lesion can reduce the size of the chalazion. Would this be an option that would help me at this point other than surgery?

Also, since I've been experiencing astigmatism for awhile now should I request for temporary prescription glasses to correct my eyesight until the chalazion resolves? I find it that from time to time the blurred vision causes problems especially when performing simple tasks such as driving during the night and using the computer.

I had requested for oral antibiotics before but my Ophthalmologist wasn't reluctant to prescribe them for me as he thought they wouldn't be beneficial. My lids aren't severe but if I do need the Azasite ointment and my Ophthalmologist doesn't prescribe the medicine to me should I ask my primary care physician instead for the prescription?

Thank you once again.

[JohnHaganMD]

No way to tell how fast or if the chalazia will go away. they never go away fast enough  for patient and doctor. If you are having trouble seeing yes get the glasses, you might be able to negotiate a discount if the RX changes over 6-12 months. Steroid injection is good option that avoids surgery.  Don't know why your ophthalmologist would not RX azasite its specifically for blepharitis.  Be sure you are using ocusoft Platinum PLUS their newest and best product.

[nimas11]

Thank you Dr. Hagan for your suggestions. I'll discuss these options with my ophthalmologist. I'll definitely try the OcuSoft Platinum Plus product.

[JohnHaganMD]

New, hard to find. Buying on internet best way.

[nimas11]

Dr. Hagan, just recently my upper right eyelid has started to flare-up due to blepharitis. It's not too puffy but it is itchy and I believe that it may turn into a sty or chalazion. What should I do to prevent the eyelid from swelling any further? I don't want to deal with another chalazion formation just like my left eyelids. Thanks.

[JohnHaganMD]

Use the search feature and archives and read about blepharitis.  Use Ocusoft Platinum Plus which is over the counter to clean your lids daily. use both the foam and the lid wipes. You may need to order on the internet as this is new product. Most stores have the very old "original" formula (black bottle) or "Platinum" (light blue bottle).  The Platinum Plus offers new type of protection. Don't pick at your eyelashes and keep your hair short enough that it does not rub on your eyelids.

[nimas11]

Dr. Hagan, so I've finally decided to have my chalazia surgically removed since I have had them for so long and they have been causing vision problems. I will have three removed in total. I've seen an oculoplastics surgeon and he will perform the procedure. I just have a few questions I wanted to ask you:

I want a corneal topography scan done before the procedure and one done afterwards just to monitor the improvement of the induced astgmatism. My surgeon recommends that it may be better to do the corneal topography scan a few weeks after the chalazia surgery instead. Should I have the scan done before the procedure or just wait? The reason I want done before is to compare the scan before and after surgery and of course to see if the astigmatism is in fact caused by the chalazion.

Also, I've been told that the chalazion in my left eye has been inducing irregular astigmatism and that glasses won't fully correct the astigmatism in that eye and if I'm looking for a temporary solution then contact lenses will help. Is it normal for chalazion to induce irregular astigmatism and if so do contact lenses fully correct the vision? I suffer from dry eyes because of blepharitis and mgd so I'm not sure if they will be comfortable to wear for extended periods of time.

Lastly, how long does it usually take for the induced astigmatism to resolve after chalazion surgery? The surgeon might open up the chalazia from the outside in order to avoid scar tissue. So hopefully that won't be a problem and it will help vision improve rather sooner than later. Thanks.

[JohnHaganMD]

An oculoplastic surgeon usually does not do corneal topography. You can discuss with your regular ophthalmologist or a cornea specialist getting pre op topo's  I think it would be worthwhile.  There is no data to tell you how much or if your irregular astigmatism will abate.  This is an unusual problem, it has been described in medical journals before but not usually a problem. Be sure you are doing everything you can to prevent another chalazia. Lid cleaner, warm compresses.  We have discussed many times things to reduce risk of more developing.

[nimas11]

Has there been any cases in which the astigmatism induced by chalazia didn't resolve completely? You've mentioned to some patients on ere before that a chalazion can only cause temporary astigmatism in adults and that it can't be permanent. I've done some research and have read about this problem and in many cases treating the chalazion improves the astigmatism for the paitient. I've seen my optometrist, two ophthamologists and my oculoplastic surgeon who all agree that the astigmatism is caused by the external pressure of the chalazion. The problem is that if this was the case I don't understand why they didn't recommend the the drainage procedure during my first visit in order to relieve me of my symptoms. Do patients typically have astigmatism caused by a chalazion? At least from your experience?

I also forgot to mention that I have meibomian gland dysfunction according to the oculoplastics specialist. My meibum is very thick and I tend to produce too much of it. I've been doing the warm compresses and lid scrubs as you have mentioned religiously at least four times a day and I'm also currently on a one month course of doxycycline 50 mg. Unfortunately my eyes still feel irritated and dry despite all of these treatments. I still haven't tried asazite yet though. I'm surprised none of my doctors have mentioned about it.

I'm hoping the astigmatism will eventually go away after the procedure. I can often feel the pressure the chalazion is causing on my left eye. We'll see what the corneal topography scan shows afterwards and if there is improvement.

[JohnHaganMD]

Chalazia are extremely common. rarely a week goes by I don't see one or two in the office. The great majority do not need surgery, do not cause astigmatism and can be treated medically with lid hygeine and scrubs, warm compresses and sometimes with topical or oral antibiotics.  Causing major astigmatism temporary or permanent is so rare its put in the medical journals. I have not had a patient with permanent astigmatism due to chalazia.   Use the search feature and archives and read about the treatment of blepharitis. You need to use a really good eyelid cleaner (foam and pads)  I recommend Ocusoft PLUS PLATINUM  Its relatively new and you may need to order on the internet. They have older products "original" and "plus" but the PLUS PLATINUM  foam and pad eyelid cleaner is best.  If it continues to be a problem there is an excellent prescription eyelid cleaner called Avenova   http://avenova.com/   that works well.