Purchase this article with an account.
K. Kurteeva, A. Fantin; New Surgical Technique: Use of a Chalazion Clamp During Steroid Injections into Capillary Hemangiomas of the Eyelid . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5132.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Central retinal artery occlusion is a devastating side effect of intralesional corticosteroid injection in the face and neck. Few cases of central retinal artery occlusion, including a bilateral retinal embolization following an intralesional steroid injection of infantile periorbital capillary hemangioma have been reported. The risk of embolization increases with increased volume of steroids needed for bulky lesions and high injection pressure exceeding the systemic arterial pressure, leading to retrograde flow and particle spill into arterial vasculature. Egbert et al measured injection pressured to be above 100 mm Hg in 89% of injections done by fellowship trained pediatric ophthalmologists despite the conscious efforts to provide low injection pressure. We propose a new surgical technique that promotes adjunctive use of a large chalazion clamp during steroid injections into the eyelid capillary hemangioma. The clamp will effectively limit the propagation of the steroid particles beyond the capillary hemangioma plexus regardless of the injection pressure during drug administration.
The dimensions of a large chalazion clamp will sufficiently cover the surface of the upper eyelid in most 3–18 month old infants. If greater area needs to be treated, combination of two chalazion clamps can be used. The clamp is applied at the lid margin to include the bulk of the lesion, tightened just prior to medicine administration, and released as soon as small volume injections of steroids are completed. An indirect ophthalmoscopy is performed during and after the injection to ensure retinal perfusion.
A successful single session intralesional steroid injection using a single chalazion clamp was performed on an infant with right upper eyelid hemangioma. Resolution of the eyelid lesion was noted within 8 weeks of injection without recurrence. No embolization was noted on fundoscopic exam. The infant enjoyed good visual acuity at subsequent follow–up visits.
We suggest routine use of chalazion clamp in large volume steroid injections into the eyelid capillary hemangioma to eliminate steroid particle central retinal embolization. The clamp stops tissue volume expansion during the injection decreasing the total amount of medication needed for injection. The mechanical sequestration of blood in the capillary hemangioma from systemic circulation by a chalazion clamp will ensure safe and predictable outcomes despite high injection pressures.
This PDF is available to Subscribers Only