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tags: story health dry eye ocular rosacea chalazion meibomian gland dysfunction ritesh patel

CHALAZION TROUBLES

by MATT GARVIN

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PART 1: MY STORY

Most people will go their lifetimes without ever hearing or reading this word: Chalazion. If you do become acquainted with it, you likely don't know how to pronounce it. The "ch" at the start is a hard "c", so makes a "k" sound. Even medical doctors, who might be familiar with the word, mispronounce it. You see, a chalazion, with the plural form being "chalazia", is rare. So not knowing how to say the word is understandable. But if you are prone to these rare manifestations, like I am, these odd, (usually) benign lumps that you get on your eyelids, can have a real negative impact on your quality of life. Whether you know how to pronounce them correctly or not.

When a chalazion started brewing on my eyelid for the first time, people asked what was wrong with my eye, or informed me that I had a stye.

"Styes are painful. But it will be gone in a few days," they volunteered.

However my small eye lump wasn't really painful, and was certainly not gone in a few days. It lingered, and it grew. At first it was a bit red and inflamed, but after weeks, this lump on my bottom eyelid became the same color as the rest of my eye-area. Now it was about the size of a popcorn kernel, and was showing no signs of going anywhere. It had taken hold, like a barnacle; an ever-growing barnacle. It was irritating, but did not hurt. I could feel the weight of it, but what I hated most was how unsightly it was. It looked like some weird defect, and because it was right near my eye, everyone seemed to notice it. It made me self conscious. I especially detested when people commented on it, or asked me about it.

It was over a decade ago, in 2007, when I came down with my first chalazion. The internet was in full swing, and when my "stye" didn't go away, I started doing my own research. There wasn't much out there. But I did come across the word for the first time: "Chalazion". And I was relieved to read it was almost always benign, and for the most part considered a cosmetic issue. What I did not like reading was how long they could last, and how big they could become. (They could last months or years, and could become pea-sized or even bigger.) Worst of all, people that suffered from one were prone to more.

Since this initial incident, I have come down with them many times, confirming I am indeed prone to them. I have had them on both eyes, on the top and bottom. (Though more frequently on the bottom, which makes my case unusual. More on this in a bit.) Over the years, I have seen many eye experts, and time and time again was disappointed by them. Until at last I found a good one, a true expert in the field. He helped to set me up with a regimen that I use to this day, that helps keep these irritating buggers at bay.

Before I met him, I saw at least 10 different eye doctors, while I had a blooming chalazion (or multiple), or in between blooms, when I sought to prevent them. Ultimately, I came to realize I suffered from chronic dry eye, as well as ocular rosacea, both of which related to another condition: Meibomian Gland Dysfunction (MGD). For me, this MGD led to chalazia. Of these 10 experts, about half mentioned dry eye, and only 2 or 3 mentioned MGD. And none of them, until I met my guy, Dr. Ritesh Patel, was willing to offer me hands-on treatment to really take charge of my difficult situation.

Meibomian Gland Dysfunction is when your meibomian glands don't behave the way they should. Meibomian glands are little glands located just below the edge of your eyelids. The glands are a little ways down, but have these little tubes (ducts) that connect to your lids, very close to the surface of your eye. These glands release meibum, which is an oil, that travels through the tubes and helps generate your tear film. (Tear film is three things: meibum, mucus, and of course, water. If you don't have enough meibum, or the meibum you have is of poor quality, your tear film will evaporate too quickly, which is one cause of dry eye.) There are more meibomian glands on your top eyelids than your bottom¹, which is probably why chalazia are more common on your top eyelids. (Though as I mentioned, this has not been my experience; I get these bothersome lumps more on the bottom.) Many people have MGD and never develop a chalazion. They just get dry eyes, and the many symptoms that accompany them.

Figure A - The little yellow ovals are where the meibomian gland ducts meet the eyelid. ( Image ©2021 Matt Garvin )

Every time you blink, these little meibomian glands pump out a little squirt of oil; if they are working correctly, that is. However, if the oil gets too thick, for many reasons, or if the little ducts get clogged, also for many reasons, you are in danger of developing a chalazion. In 2007, I didn't know what I know now, and have shared in these last two paragraphs. And my feeling is, most of the eye doctors I sought out, to help with my recurring chalazia, didn't know or fully appreciate these facts, either.

This lack of education, or familiarity, from eye doctors, was surprising to me. I live in a major city: Toronto, the biggest city in Canada. My own research indicates that dry eye is the number one most common eye issue for which people seek an eye doctor. Further, MGD is the number one cause of dry eye. Therefor MGD must be very common². Now, it could be that the eye doctors I saw that did not mention MGD, felt it was "above my head." But I do not think this was the case. Especially back in 2007, and the years shortly thereafter. Since I first saw Dr. Ritesh Patel in 2017, I no longer needed to find another eye doctor, so it is possible that the field has caught up to the scope of the problem, at long last. But I doubt it, honestly. In any case, Dr. Patel was very familiar with MGD, and he made a great impression on me right from the start.

His clinic is called "See & Be Seen Eyecare". It is located in Liberty Village, in a funky little shop near the Brazen Head Irish pub. The clinic seems pretty hip, and has young, friendly staff, though these characteristics are not really selling points to an old curmudgeon like myself. What is a selling point to me is that after almost 10 years of seeking relief, I finally found it. And at last a chronic problem I suffered from, became... manageable.

Though my treatment started the same day I first met Dr. Patel, it took a few sessions to come up with a protocol that worked for me. Everyone has a slightly different case, and most necessitate some degree of trial and error. I am going to list what my routine is, and has been for a few years. Though my protocol is no doubt unique, it is my hope it will be of some value to others in a similar situation.


FOOTNOTES
  1. "There are approximately 20 to 30 meibomian glands on the lower lid and 40 to 50 on the upper lid," from https://www.reviewofophthalmology.com/article/the-form-and-function-of-meibomian-glands
  2. "Dysfunction of these glands is a common disorder, with a widespread prevalence of 39 to 50 percent of the population," from https://www.reviewofophthalmology.com/arti...

- END OF PART 1 -
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This writing above is one chapter from the the short article "Chalazion Troubles".
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