Dear Editor,

We have studied with interest the publication“Effectiveness of oral probiotics supplementation in the treatment of adult small chalazion” by Filippelli

.

The conclusion of this work is exciting: the dialogue between gut and eye (brain) is now under the magnification lens and it deserves to continue the relationship studies, previously started by Filippelli

also on children.

Chalazion is a lipogranuloma due to occlusion of the excretory duct of the Meibomian gland, which can also have an acute inflammatory phase, as for the external sty (inflammation of the Zeiss gland of the eyelash bulb

). The traditional use of topical antibiotics (and/or, for a short time, systemic therapy) active on matrix metalloproteinases (MMPs; a class of tetracyclines such as doxycycline; caveat: age over 14y) is advised. The use of third generation aminoglucoside derived from

and used against infections by Gram positive, negative and

,or quinolones, or third generation macrolides, does not seem recommended: this suggestion also derives from a

on the need for reduce the consumption of new generation antibiotics for trivial pathologies in order to avoid the selection of resistant germs, as it has been discussed in the FEOph Round Table in Paris

. Hot moist post-medication compresses are combined to increase the absorption of the drug with vasodilation and thin the lipogranuloma with petroleum jelly and emollient paraffins. Dietary reduction of whole milk, butter, chocolate, salami, cured meats, sausages,animal fats is prescribed, and the intake of fluid extracts of

,

,

, and

as choleretics/cholagogues is recommended: this has always been the clinical protocol for small/medium sized chalazion.To add probiotics to restore the microbioma, will be our next step. The steroid in the ointment seems to favor the encystment of the granulomatous gland, it appears to rapidly reduce inflammation, but frequently without reopening the excretory duct of the meibomian gland, thus evolving into blepharoliths,calcareous conjunctival concretions.

Frezzotti and Guerra

, residing in the Emilia-Romagna/Tuscany regions, Italy, where an important component of diet is based on pork meat, summarized the pathogenesis of this epithelioid and lipophagic giant cell granuloma: “l(fā)inked to lipid metabolism disorders in people with even mild dysfunctions of the digestive system and with severe eating habits (inveterate pig eaters). Basic therapy is dietary.”

The presentation of this study with rigorous methodology,beyond the statistical demonstration of the efficacy of a noncommercial innovative product, has the merit of opening the need for further investigations on the entero-eyelid mechanism of the chalazion forming, on the standardization of the evaluation method, still empirical, here effectively simplified in the criteria: size and resolution time with therapy, possibly including, in the future, also the degree of inflammation, to drive a guide-line for the real need of topical/systemic antibiotic therapy.

點(diǎn)外賣(mài)時(shí)，最好選擇那些派送及時(shí)，且具備一定貯藏保鮮條件的餐館，比如使用密封保鮮盒盛放菜品、采用低溫冷鏈配送等，這些措施有助抑制微生物生長(zhǎng)繁殖，避免引發(fā)食源性疾病。

實(shí)訓(xùn)課程開(kāi)課前，由教研組教師集中討論，選擇出需要與患者互動(dòng)的基護(hù)操作，設(shè)計(jì)適用該操作的病例，并針對(duì)病例設(shè)計(jì)對(duì)話。對(duì)話要求簡(jiǎn)潔明了，能夠體現(xiàn)該項(xiàng)操作特點(diǎn)與注意事項(xiàng)，符合臨床實(shí)際。在上課前將病例和對(duì)話交給護(hù)生，要求其熟悉病例，熟練掌握對(duì)話內(nèi)容。實(shí)訓(xùn)課上，先由教師示教，強(qiáng)調(diào)對(duì)話內(nèi)容，然后督促護(hù)生進(jìn)行小組練習(xí)，結(jié)合提前掌握的對(duì)話內(nèi)容，分角色演示案例。

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1 Filippelli M, dell’Omo R, Amoruso A, Paiano I, Pane M, Napolitano P, Campagna G, Bartollino S, Costagliola C. Effectiveness of oral probiotics supplementation in the treatment of adult small chalazion.

2022;15(1):40-44.

2 Filippelli M, dell’Omo R, Amoruso A, Paiano I, Pane M, Napolitano P, Bartollino S, Costagliola C. Intestinal microbiome: a new target for chalaziosis treatment in children?

2021;180(4):1293-1298.

3 Frezzotti R, Guerra G.

. CEA, Milano, Italy. 2006.

4 Antibiotic prophylaxis related to intravitreal injection and cataract.FEOph Symposium and Roundtable Discussion. Available on May 7,2016. https://feoph-sight.eu/feoph-symposium-sfo-2016/