We thank Dr Norris for his useful comments regarding our article.
Patients were randomized according to which day they presented to the clinic. The office manager assigns each new patient to the first available clinic day until reaching a predetermined quota. This quota varies regarding how many physicians attend the oculoplastic clinic that day; hence, we do believe it is a good method of randomization even if not perfect. Moreover, only patients seen by the corresponding author (G.B.S.) were enrolled into the study, and this is solely by chance; if another physician examined them he would treat them according to his belief.
We did not address the issue of how many eligible patients were enrolled since only 2 patients whom we invited to participate in the study refused, having heard possible adverse events of triamcinolone acetonide (TA) injection. We even described the remote possibility of vision loss second to embolic phenomenon even though this complication was not described after periocular TA injection. In our previous report we did not encounter any major adverse effect after TA injection. I am also used to injecting 40 mg of TA into the orbit in patients with inflammatory processes such as idiopathic inflammation or thyroid eye disease with no major adverse effects. It seems that TA has a relatively high safety profile.
All patients have used conservative measures prior to attending the oculoplastic clinic, most being warm compresses and eyelid hygiene. Some have used antibiotic or steroid ointment several weeks to months prior to surgical intervention and we do not believe this can influence the outcome of the treatment. All patients attended the clinic with no signs of inflammation, rather chronic chalazia. We do not tend to intervene in patients with acute lesions and some signs of inflammation since most of these resolve spontaneously or with conservative measures.
We do agree that a relatively short follow-up time of 1.4 months may suffice to determine success; however, depigmentation may occur at a later stage. I do tend to follow up patients with subcutaneous precipitates for longer periods of several months, and none of these patients developed depigmentation or subcutaneous fat atrophy.
In addition, Dr Norris is right—and this should be further emphasized: we do not recommend revising the paradigm of surgery for chalazia; rather, we seek to offer an additional useful alternative to surgery. One should not forget that surgery requires a procedure room or even an operating theatre, higher costs, and longer rehabilitation time. Most patients who underwent TA injection return to work the next day with minimal to no bruising in the eyelid. Patients who fail to respond to 1 TA injection can still undergo surgery at a later stage, but this is not the majority of cases.