Tarsal cysts (chalazions or Meibomian cysts) and granulomas

Cysts sometimes form in the Meibomian glands on the conjunctival side of a patient's tarsus. They present as a swelling in either lid, which may become chronically or acutely infected. Small asymptomatic ones need no treatment, and may resolve spontaneously. Incise an acute infection and curette a chronic one. These cysts are common everywhere, so that treating them is a common outpatient eye operation. Sometimes, they present as granulomas.

Fig. 24-11 CURETTING A TARSAL CYST. A, a chalazion close to a patient's medial canthus. B, chalazion forceps. C, local anaesthesia. D, the chalazion clamp in place ready to incise a chalazion in the centre of his lower lid. E, curetting it.

TARSAL CYSTS EQUIPMENT. Chalazion clamp, No. 11 scalpel blade and curette.

ANAESTHESIA. Anaesthetize the patient's conjunctiva with drops of lignocaine 4%, or amethocaine hydrochloride 1%. Infiltrate his lid with lignocaine and adrenalin around the chalazion. Insert the needle at the upper margin of his upper tarsus, and the lower margin of his lower tarsus. Carry it forwards to his lid margin, on either side of the chalazion.

CURETTAGE. Evert his lid slightly. Put the chalazion clamp over the cyst, so that the solid blade lies on the skin of his eyelid, and the ring lies on his conjunctiva over the cyst. Close it so that it holds the lid and the cyst. Insert the tip of a No. 11 blade, so that it cuts away from his eye. Alternatively, make a cruciate incision. Swab its contents clean.

CAUTION ! Take care to curette away any pockets of granulation tissue, which may be hidden by a flap of conjunctiva, or have herniated themselves through his tarsal plate into his orbicularis muscle. If you don't do this, it may recur.

Remove the clamp and pinch his lid until it stops bleeding. If this is troublesome, wash it with warm saline. Place antibiotic ointment in his conjunctival sac 3 times a day for a week.

If the MATERIAL YOU INCISE IS HARD, and not gelatinous, suspect a carcinoma. Send it for histological examination, and refer him.