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D. S. Bardenstein; Systemic Bacteriocidal Antibiotics as the Treatment for Chalazia: Pathogenetic and Therapeutic Implications. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5236.
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To examine the role of bacteriocidal systemic antibiotics in the management of chalazia.
We studied 3 patient types. Initially, patients with recurrent chalazia or those who were poor surgical candidates were given the option of systemic treatment (N=5). A second group included patients unlikely to comply with multiple and extended use of compresses and topical medications (N=4). Ultimately, all patients with suspected chalazia were offered this treatment (N=6). Both patients with clearly identifiable whitish mass lesions consistent with chalazia and those with diffuse redness and pain were included. Exclusion criteria were long standing unchanging lesions and cephalexin allergy. After being informed of the standard options for treatment, patients were given the option of cephalexin 250mg qid for one week. Patients electing cephalexin treatment were examined at weekly intervals. Warm compresses or topical antibiotics or steroids weren't used. Symptoms were recorded as improved, worsened or stable. Objective data: size of the mass, swelling and redness were similarly evaluated. Treatment was extended if there was improvement. Treatment endpoints included: resolution, cessation of improvement and failure to respond. All patients were queried each visit while on treatment regarding antibiotic side effects.
Of 9 patients with early lesions both initial and recurrent, all but 1 responded objectively. In all patients, redness decreased or disappeared. The size of the lesions when present decreased in 80% of patients. 30% had residual mass requiring treatment with intralesional corticosteroid or excision. In the most extreme case, a 2 cm lesion essentially resolved after 6 weeks of treatment. No complications of antibiotic treatment were experienced. In responsive patients, intermittent medication use resulted in improvement and worsening parallel to antibiotic use. No patient worsened.
Controversy has existed over relationship between infection and reaction to foreign material as the initiating factor in chalazion formation. This study suggests that infection has the greater role since almost all patients responded with some having a complete response. Large lesions also responded suggesting that some of the mass forming changes are reversible. The use of frequent topical treatments which is often a compliance problem was unneeded. In this small study, the theoretic risks of systemic treatment were not observed. A larger prospective study could answer questions regarding risk and efficacy in all situations.
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