An intralesional triamcinolone acetonide injection is one of the treatment options for chalazia. However, lesions clinically resembling chalazia may occasionally represent other pathological entities, potentially leading to unexpected complications after treatment. We report the case of a 54-year-old man with a left upper eyelid mass initially diagnosed as a chalazion and treated with an intralesional triamcinolone acetonide injection. The following day, the lesion showed marked worsening, with swelling, redness, and pain. Imaging revealed a cystic lesion, and bacterial infection could not be excluded. Intravenous antibiotics were initiated; however, the lesion continued to worsen, and drainage yielded sterile purulent material. Surgical excision revealed a cystic lesion containing keratinous material. Histopathological examination demonstrated marked inflammatory cell infiltration without granulomatous inflammation or lipid-laden macrophages characteristic of chalazion. Based on the surgical findings, histopathological findings, and clinical course, the lesion was diagnosed as an intratarsal keratinous cyst complicated by rupture and foreign body inflammatory reaction following intralesional steroid injection. This case highlights the importance of careful differential diagnosis in eyelid lesions mimicking chalazia. An intralesional steroid injection may cause severe inflammatory complications when administered to inappropriate lesions.

Anterior segment eye diseases significantly affect patients' quality of life (QoL) by impairing physical health, psychological well-being, social interactions, and economic stability. Conditions such as dry eye disease, blepharitis, conjunctivitis, keratoconus, keratitis, and corneal dystrophies cause chronic discomfort, visual disturbance, and emotional distress, leading to reduced daily functioning and work productivity. Other disorders like chalazion, trichiasis, ptosis, strabismus, and thyroid eye disease entail a psychological burden by affecting appearance and social confidence. This narrative review comprehensively examines the multidimensional impact of anterior segment diseases on QoL. A systematic literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar for English-language articles published between December 1997 and February 2025. Using relevant keywords and Boolean operators, we initially identified 854 articles. Following duplicate removal and screening based on inclusion and exclusion criteria focused on QoL-related outcomes in anterior segment diseases, we selected 72 high-quality studies for the review. This methodology ensured a thorough and focused analysis of the available evidence. Findings highlight the importance of addressing both clinical symptoms and psychosocial effects in management strategies. Future research should emphasize interventions that improve ocular function alongside overall well-being.

Blepharitis is a chronic inflammation of the eyelid margin that is mediated by the immune system. It is one of the common ocular surface diseases and often leads to serious sequelae that threaten vision, such as dry eye syndrome due to insufficient tear secretion, corneal neovascularization, and stubborn chalazion. Elucidating its precise etiology is therefore imperative. Emerging high-throughput sequencing and metagenomic analyses have unveiled a quantitative and qualitative disruption of the periocular microbiome (dysbiosis), characterized by the expansion of specific bacterial species such as Staphylococcus aureus, coupled with episodic blooms of Demodex. These perturbations are no longer considered epiphenomena. In this review, we reveal the possible mechanisms of the role of blepharitis and microbiota dysbiosis.

BACKGROUND Pyoderma gangrenosum (PG) involving the eyelid is rare and can closely mimic other differential diagnoses, posing a diagnostic challenge. This case highlights the diagnostic approach and management of pyoderma gangrenosum-related eyelid lesions. CASE REPORT A 29-year-old man with a history of ulcerative colitis developed a persistent ulcerative lesion on his left upper eyelid, which failed to respond to conventional treatment for chalazion. Examination revealed a pinkish-yellow ulcerative lesion with ill-defined borders, causing distortion of the eyelid margin contour. Due to the potential for malignancy or atypical inflammatory disease, an incisional biopsy was performed. Infectious, rheumatologic, and vasculitis workup results were negative. Histopathological findings were consistent with a diagnosis of eyelid pyoderma gangrenosum. Initial treatment with intralesional triamcinolone resulted in limited improvement. In collaboration with the patient's gastroenterologist, the biologic immunomodulator ustekinumab was administered, leading to a substantial reduction in lesion size. To our knowledge, this represents the first reported case of eyelid pyoderma gangrenosum successfully treated with ustekinumab. At the 3-month follow-up, the eyelid lesion demonstrated considerable improvement. The patient remained stable without recurrences during 1 year of follow-up. CONCLUSIONS Pyoderma gangrenosum is a rare and aggressive condition that should be considered in the differential diagnosis of any ulcerative eyelid lesion. Given the diagnostic difficulty, management should focus on controlling the underlying systemic disease in collaboration with a gastroenterologist. Early diagnosis and appropriate management are crucial to prevent facial disfigurement and the need for complex eyelid reconstruction.

This report describes the case of a four-year-old girl with idiopathic facial aseptic granuloma (IFAG) who developed persistent, treatment-resistant eyelid and facial inflammation despite multiple courses of antibiotics and corticosteroids. Her presentation included recurrent hordeola, severe blepharitis, and a cheek nodule, with a clinical picture more consistent with IFAG than pilomatrixoma despite histologic evidence of the latter. Standard therapies provided only transient benefit and were limited by systemic side effects. Initiation of topical tacrolimus 0.03% ointment led to rapid and sustained improvement in redness, irritation, and nodularity. This case highlights topical tacrolimus as a promising non-steroidal option for children with prolonged or refractory IFAG.

Extraocular disorders and their surgical management can significantly influence corneal astigmatism and higher-order aberrations (HOAs). This review aimed to evaluate the relationship between extraocular conditions, their surgical correction, and subsequent changes in corneal astigmatism and HOAs. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science, including studies published between 1992 and 2024. Search terms included astigmatism, eyelid surgery, thyroid eye disease (TED), orbital decompression, blepharoplasty, chalazion, dermatochalasis, ptosis, pterygium, scleral buckle, and HOAs. The reviewed literature demonstrates that a wide spectrum of extraocular disorders (such as ptosis, dermatochalasis, TED, chalazion, and pterygium) are associated with clinically significant changes in corneal astigmatism and HOAs. These alterations are affected by factors including lesion size, anatomical location, and the type of surgical intervention. For instance, ptosis surgery may either reduce or induce astigmatism depending on patient age and surgical technique, while chalazion excision and pterygium removal frequently lead to meaningful reductions in astigmatism and HOAs, particularly in cases involving larger lesions. The timing of postoperative evaluation and surgical approach plays a critical role in the magnitude and persistence of these optical changes. Awareness of the impact of extraocular diseases and their surgical treatment on corneal astigmatism and HOAs is essential for accurate interpretation of refractive changes, postoperative follow-up, and optimal patient management.