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Recurrent Chalazion Question
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Recurrent Chalazion Question

I have a chalazion on my upper eyelid.  It's been there for about two years.  I had it drained, then excised a few months later when it filled back up.  Within a few months of having it removed, it returned.  I tried hot packs but it kept growing.  I saw an Opthamologist twice last year.  The first visit he just encouraged me to keep doing the hot packs.  That didn't help and it had grown to the point where I couldn't open my eye all the way.   I returned to the doctor and he injected it with a steroid.   It did shrink down but never went away completely.  This was last December.  It has now grown to about the same size as it was before the injection (about the size of a pea).

I want to get it removed but I want to be sure if I do that it will be gone for good.    I don't think I want the Opthamologist I saw last year to remove it because he said he would go in under the eyelid.  My previous Opthamologist (in another state) said that it isn't a good idea to be cutting the underside of the eyelid.

So, I guess I have a few questions:

1.) Is removing the growth through the underside of my eyelid not the best way to go about it?

2.) What are some reasons why it keeps recurring (always in the same spot) and should I be concerned that it is something other than a chalazion?

3.) How can I go about finding an expert in chalazions in either Portland (OR), Boise (ID)  or Seattle WA?

Thanks
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These are very good questions.  First, some people just continue to get recurrent chalazia due to very oily eyelids and a tendency to get clogged up meibomian glands.  I have one patient that I must have seen for 10 different ones.  It has a lot to do with genetics, skin type, dietary intake, the level of stress hormones, and other factors that we don't even understand yet.  I would work on having a very healthy diet rich in good fruits and vegetables with lots of good hydration every day.  Keep the stress level down.  Keep excellent lid hygeine by using warm soaks on lids every day and possibly using sterilid or ocusoft lid scrubs on lids daily.

The best way to surgically approach a chalazion is from under the eyelid through the conjuctiva.  Through the skin is rarely used.  Personally, I now try to avoid surgical excision if at all possible because it is somewhat uncomfortable for the patient and steroid injection seems to work better and more efficiently for me in 90% of cases.  I used to excise about 1 or 2 chalazia a month, now I excise just 2 or 3 a year.  I inject almost all now - but again - that is just my personal preference because I alway saw excision as being a fairly unpleasant experience for most patients and I'm all about keeping patients comfortable and happy.  Finally it is common for a chalazion to come back in the same area because the meibomian glands are damaged and irritated there.  

I'm sorry but I know no one in your area.  Make sure you see a board-certified ophthalmologist.  Perhaps you can ask your primary care doctor who he sees or recommends.

Good Luck.
Michael Kutryb, MD
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