Case introduction

A 3-year-old Caucasian child was brought in for a consultation for a chalazion that had persisted in her right eye for two weeks, accompanied by inflammation of the eyelids. Parents reported a growing bump on the upper right eyelid, leading to visual discomfort and local redness. The diagnosis confirmed the presence of a chalazion and Demodex blepharitis, classified as grade 3 OD (right eye) and grade 2 OS (left eye).

The child's environment included several doggies (more than seven) and a down jacket that she kept to sleep. Further evaluation revealed grade 1-2 meibomian gland atrophy in both eyes.

Treatment History

Previous treatments included:

• Tobradex (antibiotic eye drops and corticoids) administered twice daily.
• Hot compresses applied two to three times per day.

Despite these measures, the bump on the eyelid continued to grow, leading to a consultation at our clinic for further evaluation and further management.

Approach and Results

Full care was put in place after the initial assessment:

1. Home measurements:
   • Prescription of wipes Blephadex for daily eyelid cleaning.
   • Application of a warming mask three times a day, followed by gentle eyelid massages.
   • Reducing the number of dogs in the bed to one and keeping the preferred down jacket. The dogs and the down jacket were washed, and parents were advised to wash the pillowcases more frequently.
2. Clinical interventions:
   • Several sessions of photobiomodulation (LLLT) to reduce inflammation and stimulate chalazion resorption.
   • Eyelid cleaning with the ZEST protocol to remove residues and improve eye hygiene.
   • During the second follow-up, a meibography was performed, confirming grade 1-2 meibomian gland atrophy in both eyes.

Monitoring progress:

• Follow-up 1: 50% improvement. The chalazion broke out spontaneously the following weekend, causing a marked decrease in the hump and inflammation.
• Follow-up 2: The bump is barely visible, with no residual redness.

• Follow-up 3: Complete resorption of the chalazion.
• Follow-up 4: A minor recurrence was noted, accompanied by inflammation of the eyelids. The treatment was adjusted, replacing the Blephadex wipes with the foam Zocufoam once a day, and eyelid cleaning was performed in the clinic. A meibography made it possible to evaluate the meibomian glands, showing bilateral grade 1-2 atrophy.

• Follow-up 5: Complete resolution of symptoms. Blepharitis is now better controlled thanks to an adapted eye hygiene routine.

Follow-up plan:
Follow-up every six months is recommended for eyelid cleanings and photobiomodulation sessions. Daily use of Zocufoam foam will be maintained to reduce the risk of recurrence and to ensure continued management of blepharitis.