Management and outcomes of proteasome inhibitor associated chalazia and blepharitis: a case series

Abstract

Background: The purpose of this case series was to further characterize proteasome inhibitor associated chalazia and blepharitis, to investigate outcomes of different management strategies, and to propose a treatment algorithm for eyelid complications in this patient population.

Methods: This retrospective case series included sixteen patients found to have chalazia and/or blepharitis while receiving proteasome inhibitors for plasma cell disorders at Mount Sinai Hospital in New York, NY from January 2010 through January 2017. Main outcomes were complete resolution of eyelid complications and time to resolution. Student's t-test was used to compare average values and Fisher's exact test was used to compare proportions.

Results: Fourteen patients had chalazia and 10 had blepharitis. Chalazia averaged 5.4 mm, and 11 patients with chalazia experienced two or more lesions. Median follow-up time was 17 months. Average time from bortezomib exposure to onset of first eyelid complication was 3.4 months. Chalazia episodes were more likely to completely resolve than blepharitis episodes (p = 0.03). Ocular therapy alone was trialed for an average of 1.8 months before proceeding to bortezomib omission. Average time to eyelid complication resolution using ocular therapy alone was 1.8 months versus 3.1 months after bortezomib omission. In this series, the combination of ocular therapy and bortezomib omission led to complete resolution of eyelid complications more often than ocular therapy alone.

Conclusion: Proteasome inhibitor associated eyelid complications were identified in sixteen patients with plasma cell disorders. Eyelid complications may be treated with a 2-month trial of conservative ocular therapies alone, followed by continuation of ocular therapy in combination with bortezomib omission if eyelid signs persist.

Keywords: Blepharitis; Bortezomib; Chalazia; Chemotherapy; Eyelid; Multiple myeloma; Plasma cell disorder; Proteasome inhibitor.

Fig. 1

Management and outcomes of eyelid complications in sixteen patients with plasma cell disorders on proteasome inhibitors. A stacked bar graph demonstrating the number of episodes of chalazia and blepharitis that resolved or persisted based on treatment with ocular therapy alone, bortezomib omission alone, a combination of the two, or no treatment/observation

Fig. 2

Outcomes of specific ocular treatment options used for eyelid complications in sixteen patients with plasma cell disorders on proteasome inhibitor therapy. A stacked bar graph demonstrating the number of episodes of chalazia and blepharitis that resolved or persisted based on specific ocular therapies such as hot compresses, topical antibiotics and/or steroids, oral antibiotics, or oral steroids. Topical antibiotic and/or steroid drops and ointments used included tobramycin, tobramycin/dexamethasone, azithromycin, erythromycin, bacitracin, loteprednol, and dexamethasone. Systemic antibiotics used included doxycycline, cephalexin, gentamicin, and ciprofloxacin. Oral steroids used included methylprednisolone

Fig. 3

Treatment algorithm. A proposed management sequence for patients with plasma cell disorders and proteasome inhibitor-associated eyelid complications