August 8, 2014
We celebrated the twins’ first birthday last week. The little bit of caffeine in the chocolate cake woke them up from sleep two to three times that night. It goes to show that they are still sensitive little creatures but by and large, they are healthy and happy babies. The weeks in the neonatal intensive care unit is now a distant memory and the nagging fear that something will go wrong with their health faded away. Bringing them from low-birth-weight premies to babbling and crawling babies gives my wife and I a great sense of accomplishment. Most of all though, this landmark is a time to pause and reflect on how truly fortunate and blessed we are.
I run with the twins often in their bright orange double “Bob” stroller. Our usual route from our home takes us through a beautiful half-mile stretch of road that has multiple speed bumps and a speed limit of 15mph. I am often surprised to see that drivers slowed their cars down even more just to get a glimpse of the twins. Invariably, the twins bring a smile to their faces. They can melt the most taciturn face into a smirk or even joy. I wonder why that is. Is it because the twins are just so darn cute, like one would smile when you see a puppy pile? I think it is more than that. I think babies remind us of the infinite possibilities that once lay ahead each of us. That sense of hope and innocence is rekindled in a place deep within us when we meet a baby and that is why they are blessings to us all.
I mentioned the twins often in this blog but my oldest daughter Claire is an equal blessing to me. She is now twelve and a great big sister to the twins. It is interesting to be a father to two children who are utterly dependent on you while another child is desperately trying to become independent from you. Claire is already showing the tell-tale signs of a teenager: rolling her eyes when I try to teach her anything, dramatizing every incident at school to an apocalyptic ending and pushing boundaries in her socialization with friends, girls and BOYS included. Last month, I noticed a good -sized pimple on the tip of Claire’s nose and I offered to remove it for her. She declined. I jokingly said that the pimple is a distraction when boys try to look at her and that comment earned me a punch in my abdomen. Raising twin babies is in some ways easier. I might be sleep deprived but it sure hurts less.
A pimple on the nose may engender the wrath of a pre-teen daughter but a pimple in the eyelids is no laughing matter either. Along the margin of the eyelids, there are glands that produce oil which is an essential component of the tear film that coats the surface of our eyes. When these glands produce too much oil, they can get clogged up. The oil is then extruded into the surrounding eyelid tissues which elicits an inflammatory reaction to produce a chalazion. A stye or hordeolum is an acute infection of these plugged up glands, usually located in the front part of the eyelid. It can be quite painful. As opposed to a stye, a chalazion is more akin to a pimple and represents a chronic local inflammation and is generally painless. It is usually located in the deeper area of the eyelid and it may secondarily cause an exuberant growth of scar tissue and small blood vessels mass known as pyogenic granuloma on the internal surface of the eyelid.
Chalazion generally does not interfere with vision but a large persistent chalazion may indent on the cornea to cause astigmatism. The patient may then experience blurry vision as a result of the induced astigmatism and amblyopia (lazy eye) has been reported due to chalazion in children. It is my clinical impression, as well as others that Hispanic children tend to get chalazion more frequently and recurrently. It is unclear whether there is a genetic or dietary component here. Interestingly, dietary supplementation of omega-3 fatty acids such as fish oil has been shown to change the composition of the oil produced in the eyelid glands. This may, at least in theory, reduce the likelihood of occurrence of a chalazion. Controversy exists as to whether fish oil intake is linked to prostate cancer in men. While fish oil is good for many things such as dry eyes, blepharitis and cardiovascular health in general, men might need to balance that against their individual risk factors of developing prostate cancer.
The first line of treatment for a chalazion or a stye is hot compresses. The heat and the mechanical motion of rubbing the lid margin help to melt open the plugged up glands to allow it to drain. A combination of antibiotic and steroid eye ointment may provide added benefits. I usually recommend medical therapy for at least two weeks before surgical intervention. Surgery, however, is relatively low-risk and can be done as an in-office procedure for adults. It involves flipping the eyelid outwards with a clamp and an incision is made on the internal surface of the eyelid to drain the pus out. We often remove a small piece of the tissue and leave the incision open to allow it to continue to drain. Antibiotic ointment and a patch are applied which can be removed in couple of hours.
An alternative to surgical drainage is injection of a steroid suspension to the lesion. I tend to recommend this treatment when the lesion is small and indurated without a lot of pus in it. Patients with dark skin may develop whitening of the eyelid skin in the area where it is injected and I try to avoid this method for these individuals. In kids, either method poses a risk of damaging the eyeball and therefore we have to do them under general anesthesia.
If left untreated, many chalazia will eventual go away. Rarely, an untreated stye or chalazion can become infected and the infection can extend to the entire eyelid and possibly into the eye socket. Even more uncommon is the occurrence of eyelid gland cancer that can masquerade as a chalazion. For these reasons, medical attention should always be sought for unresolved or recurrent chalazion.