Is the Use of a Steam Mask an Effective Treatment for Paediatric Chalazion in Comparison to Traditional Warm Compresses?

Protocol

Is the use of a steam mask an effective treatment for paediatric chalazion in comparison to traditional warm compresses?

Background

Chalazia are chronic sterile lipogranulomas of the meibomian or Zeis glands that can be refractory in nature due to retained sebaceous secretions. Histopathology of chalazia identifies a chronic inflammatory picture, with extracellular fat deposits surrounded by lipid-laden epithelioid cells, multinucleated giant cells and lymphocytes. The condition can often be associated with diagnoses, such as blepharitis, meibomian gland dysfunction and dry eye disease. Chalazia will often present as a gradual, painless and round lesion on the either the upper or lower eyelid. It is expected to be non-tender (unless associated with acute inflammation due to infection), non-fluctuant and non-erythematous, and can either present as a single lesion (chalazion) or as multiple lesions (chalazia). Symptoms can present as reduced vision, epiphora, irritation and cosmetic concerns. For paediatric chalazion, an incidence of 2% has been found, which would account for approximately 288,071 of the UK population aged under the age of 18 years, according to population statistics.

The condition is known to be benign and self-limiting in nature, but time until resolution can vary, and therefore treatment is often sought. Management of chalazia usually begins with warm compresses, eyelid massage and eyelid hygiene, unless the patient presentation dictates a more medicalised approach, for example, in cases of cellulitis. Warm compresses provide heat to the chalazion in order to melt the meibum obstructing the meibomian gland. The average melting temperature of meibum is approximately 32oC, increasing to approximately 35oC when there is an obstruction or altered secretions, and therefore it is recommended to achieve a heat of 40oC for therapeutic treatment. A secondary benefit of a heat source in the form of a warm compress is due to activation of the heat shock response and subsequent expression of localised heat shock proteins (HSP). HSPs maintain cellular protein homeostasis (proteostasis) by acting as molecular chaperones and assisting in folding of polypeptides, and other cellular activity, ensuring the normal functioning of cells. Therefore, once activated, the HSPs will assist in functions such as degradation of misfolded proteins and apoptosis regulation, both important functions for cells/tissue damaged by inflammation. HSPs have also been found to inhibit the transcription of genes encoding pro-inflammatory cytokines. Histopathological analysis of chalazion shows the presence of inflammatory cells, and therefore the presence of a heat source may help inhibit the inflammatory response of the chalazion and promote normal functioning of cells. In experimental disease models, HSPs have been shown to prevent or arrest inflammatory damage for patients with chronic inflammatory diseases. As a chalazion is a chronic inflammatory condition, activation of HSPs at the site of the heat source may reduce the inflammatory component of the condition.