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: “linked 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.

点外卖时，最好选择那些派送及时，且具备一定贮藏保鲜条件的餐馆，比如使用密封保鲜盒盛放菜品、采用低温冷链配送等，这些措施有助抑制微生物生长繁殖，避免引发食源性疾病。

实训课程开课前，由教研组教师集中讨论，选择出需要与患者互动的基护操作，设计适用该操作的病例，并针对病例设计对话。对话要求简洁明了，能够体现该项操作特点与注意事项，符合临床实际。在上课前将病例和对话交给护生，要求其熟悉病例，熟练掌握对话内容。实训课上，先由教师示教，强调对话内容，然后督促护生进行小组练习，结合提前掌握的对话内容，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/