A prospective study of cost, patient satisfaction, and outcome of treatment of chalazion by medical and nursing staV

Aim—To study prospectively the outcome of conservative and surgical treatment of chalazia provided by medical and nursing staV. Methods—During a 5 month recruitment period all patients attending a district general eye hospital for treatment of chalazion were included in the study. 129 patients (217 visits) with chalazia were seen by either a senior nurse or a trainee ophthalmologist (senior house oYcer, SHO) or both. Patients received either conservative treatment or eversion of the eyelid with incision and curettage. Patients were mailed a questionnaire asking them if their cyst had resolved and how they rated their treatment. Marginal cost analysis was used to determine the cost of treatment. Results—The outcome of treatment could be determined in 170 of the 217 visits. Conservative treatment was successful for 29% of cysts while surgical treatment was successful for 72%. There was no significant diVerence in treatment outcome between nurse and SHO groups. Patients found nurse treatment acceptable with a high level of patient satisfaction. The marginal cost of treatment by a nurse was £9.91 per cyst compared with £12.10 for SHOs. There were no surgical complications and no evidence of malignancy in six biopsies. Conclusions—Surgical treatment of chalazion is safe and eVective and successfully treats approximately three quarters of selected cysts. With conservative treatment approximately one third of selected chalazia will resolve within 3 months. Nurse treatment of chalazion is safe, eVective, and acceptable to patients. (Br J Ophthalmol 2000;84:782–785) Despite being one of the commonest ophthalmic conditions there are very few large prospective studies of the treatment of chalazion. A number of relatively small trials have variably estimated the success of conventional surgical treatment of chalazion to range between 60–89% while conservative treatment may be successful for 25–77% of cysts. Without large prospective trials it is diYcult to advise patients of the relative risks and benefits of surgical or conservative treatment. This study was initiated at a time when a senior ophthalmic nurse (LB) began treating patients with chalazion. We are aware of nurse treatment of chalazion in other British centres but we do not know of any large, prospective studies on its success or safety. Without such studies hospital managers and clinicians may find it diYcult to justify the delegation of treatment to non-medical staV. By the use of a postal questionnaire this study prospectively followed the outcome of treatment provided concurrently by both nurse and trainee ophthalmologists (senior house oYcer; SHO). We also assessed various aspects of patient satisfaction. Marginal cost analysis was used to determine the cost of conservative and surgical treatment. This is the first, large prospective study we are aware of that analyses the outcome of treatment for all patients attending with chalazion thereby investigating both surgical and conservative treatment strategies. It is also the first, large prospective clinical study we know of that reports on nurse treatment of chalazion. Materials and methods During a 5 month recruitment period (January to May 1995) all patients attending a district general eye hospital for treatment of chalazion were included in the study. Patients were followed up until December 1995. Although this study was not primarily designed to compare nurse and SHO treatment, the outcome of treatment data were analysed separately for comparison. Nurse and SHO cyst treatment clinics were run independently of one another and general practitioner referrals and eye casualty patients with chalazia were allocated to the next available clinic without consideration of whether this was run by a nurse or SHO. For the purposes of comparison those patients who were referred to senior medical staV for treatment of concomitant pathology such as rosacea remained in the original study group—that is, nurse or SHO. Patients who reattended with recurrent chalazion were reallocated to the next available clinic; hence, some patients were seen consecutively by both a nurse and SHO. Nurse education in the conservative and surgical treatment of chalazia was provided by a consultant ophthalmologist and included instruction in the recognition of malignant lid lesions. A treatment protocol was designed to allow the nurse to practise independently but her clinic was run at time when senior medical staV were available for consultation. Conservative treatment included patient advice about steam bathing of the eyelids and dispensing of chloramphenicol ointment to use Br J Ophthalmol 2000;84:782–785 782 The Sussex Eye Hospital, Brighton