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      A Case of Recurrent Chalazia Associated with Subclinical Hypothyroidism

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          Abstract

          Chalazia are chronic inflammatory disorders of the Meibomian glands of the eyelids that can present at any age. Although the exact cause is still obscure, they are often associated with retention of lipids in these sebaceous glands, infections, or disturbances in the balance of sex hormones. The complications of the disease may vary from little discomfort to reduced vision. Treatment strategies include hot compresses, intralesional steroid injections, and incision and curettage. The present case is about a female in her forties with a 4-year long history of recurrent chalazia. The management of the majority of the lesions was through incision and curettage. Concomitantly she presented with subclinical hypothyroidism, for which she received treatment. During treatment of the hypothyroidism, there was a remission of the chalazia. After cessation of the treatment with levothyroxine, the chalazia started recurring. Reinstatement of a low-dose treatment with levothyroxine eventually led to a remission and prevented further recurrence of the chalazia. Subclinical hypothyroidism may predispose to recurrent chalazia. This finding may have consequences for the understanding of the pathophysiology and the management of this disorder. Further investigations must elicit the exact mechanism of this association.

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          Most cited references 20

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          Histopathology of meibomian gland dysfunction.

           V Gutgesell,  I Hood,  G. Stern (1982)
          We conducted a histopathologic study of he meibomian glands of seven patients (all men, ranging in age from 58 to 83 years) who had severe or moderately severe meibomian dysfunction and who were undergoing ectropion or entropion repair. Abnormal features included signs of obstruction and dilatation of ducts, enlargement of acini with cystic degeneration and squamous metaplasia, foreign-body reaction and granuloma formation, a mild increase in inflammatory cells, and abnormal keratinization. Demodex organisms were found in both acini and ducts of one patient. These findings were similar to those reported in other entities involving meibomian duct obstruction, probably related to abnormalities of keratinization, plays an important role in the pathogenesis of meibomian gland dysfunction.
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            Associated morbidity of blepharitis.

            To evaluate the prevalence of systemic medical conditions in patients with blepharitis. A retrospective observational case-control study. All the members who were diagnosed with blepharitis in the Central District of Clalit Health Services in Israel (years 2000-2009; n=16706) and 16706 age- and gender-matched controls randomly selected from the district members. Analysis of the prevalence of various ocular and systemic conditions, risk factors, age, gender, marriage status, country of origin, place of residency, and socioeconomic status. The prevalence of any associated morbidity. Demographically, a significantly higher tendency to develop blepharitis was found in populations of lower socioeconomic class, populations living in urban areas, and Ashkenazi Jews. A significant association of P<0.001 was found with some inflammatory diseases (gastritis, peptic ulcer, asthma, arthropathy, and ulcerative colitis), psychologic conditions (anxiety, irritable bowel syndrome, neuroses, and depression), hormonal conditions (hypothyroidism and prostatic hypertrophy), cardiovascular diseases (carotid artery disease, hyperlipidemia, hypertension, and ischemic heart disease), and other eye conditions (chalazion, pterygium). The strongest associations found were between blepharitis and chalazia (odds ratio [OR] 4.7; confidence interval [CI], 3.8-5.7), rosacea (OR 3; CI, 2.1-4.3), pterygia (OR 2.0; CI, 1.5-2.6), ulcerative colitis (OR 2.3; CI, 1.2-4.2), irritable bowel syndrome (OR 1.8; CI, 1.3-2.5), anxiety (OR 1.6; CI, 1.4-1.9), and gastritis (OR 1.6; CI, 1.4-1.7). Some ocular and systemic conditions are more prevalent among patients with blepharitis. Better understanding of the pathophysiologic association between those diseases and blepharitis may help in its treatment and prevention. The author(s) have no proprietary or commercial interest in any materials discussed in this article. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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              Retinal and choroidal vascular occlusion following intralesional corticosteroid injection of a chalazion.

              Unilateral visual loss following periocular corticosteroid injection is a reported complication of injections of tonsillar, nasal, scalp, and retrobulbar sites. This is the first reported case, to our knowledge, of intralesional corticosteroid injection of a chalazion producing ipsilateral microembolization and infarction of retinal and choroidal vasculature. An eight-year-old boy underwent reexcision of an upper lid chalazion under general anesthesia. Intraoperatively, 0.5 ml of depot-steroid preparation was injected into the excision site. Postoperatively, vision was unilaterally reduced to light perception only. Examination revealed an afferent pupillary defect, retinal and choroidal emboli, retinal edema, and a macular "cherry red spot". Anterior chamber paracentesis, carbon dioxide rebreathing, carbonic anhydrase inhibitors and ocular massage failed to change the embolic pattern. No visual recovery resulted. Fundus photography and fluorescein angiography demonstrated occlusion of the retinal and choroidal vasculature. Extreme care should be exercised during and immediately following intralesional corticosteroid injection of chalazia.
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                Author and article information

                Journal
                COP
                COP
                10.1159/issn.1663-2699
                Case Reports in Ophthalmology
                S. Karger AG
                1663-2699
                2020
                May – August 2020
                09 June 2020
                : 11
                : 2
                : 212-216
                Affiliations
                aDepartment of Physiology, Faculty of Medical Science, Anton de Kom University of Suriname, Paramaribo, Suriname
                bDepartments of Ophthalmology, Academic Hospital Suriname and Faculty of Medical Science, Anton de Kom University of Suriname, Paramaribo, Suriname
                Author notes
                *Robbert Bipat, Department of Physiology, Faculty of Medical Science, Anton de Kom University of Suriname, Kernkampweg 5, Paramaribo SR597 (Suriname), robbert.bipat@uvs.edu or robbert.bipat@gmail.com
                Article
                508603 PMC7315195 Case Rep Ophthalmol 2020;11:212–216
                10.1159/000508603
                PMC7315195
                32595485
                © 2020 The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Pages: 5
                Categories
                Case Report

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