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M. Crawford, A.M. Mansour, C.C. Chan; Identification of Viral Particles in Chalazion With Transmission Electron Microscopy . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4208.
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Purpose: Chalazion is a localized lipogranulomatous inflammation that affects the sebaceous glands of the eyelids. It may be caused by inflammation, infection or neoplasm at the eyelid margin. Bacterium is the most common infectious agent to induce chalazion. This study examines the microorganisms in 4 eyelid biopsies with a clinical diagnosis of chalazion. Methods: Four Lebanese patients with follicular conjunctivitis experienced a systemic viral illness and developed chalazia for the first time in their lives. None had a history of meibomian gland dysfunction, blepharitis or other abnormalities of the eyelids. The lesions were biopsied, fixed in 10% buffered formalin, and shipped to the National Eye Institute. The specimens were divided for paraffin and transmission electron microscopy. The paraffin embedded sections were stained with hematoxylin–eosin, periodic acid–Schiff (PAS) and Gram stain (B&B). Transmission electron microscopy was performed with a Joel 1010 electron microscope. Results: The histopathology confirmed the diagnosis of chalazia in all 4 biopsies. They were characterized by a dense mixture of lymphocytes, plasma cells, macrophages, giant cells, granulation tissue and lipid droplets. There were Gram–positive short rods in one specimen. Transmission electron microscopy demonstrated virus particles in all 4 cases. Both intranuclear and intracytoplasmic inclusion bodies with an average size of 200 nm were identified, which were compatible with herpes virus. Later, two patients developed corneal disciform keratitis consistent with herpetic keratitis. Conclusions: Virus has been associated with follicular conjunctivitis, but not in chalazion. In this study, we have shown virus particles in chalazion by transmission electron microscopic examination. In addition to inflammatory response, which may result in clogging the tiny orifices of the meibomian gland, the virus may infect the meibomian gland leading to the formation of chalazion. Intralesional corticosteroids should be considered with great caution for chalazia associated with viral conjunctivitis. Antiviral therapy may be useful in patients with viral conjunctivitis who also have a clinical diagnosis of chalazion.
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