If instructed, continue using antibiotic ointments and/or eye drops to prevent infection. We offer you complete transparency because we work for you, not the hospitals. Recovery is expected to take around a week, although the timeline may be slightly shorter or longer depending on the location and size of the chalazion. I went to an oculoplatic surgeon. Removal of a chalazion cyst. We offer you complete transparency because we work for you, not the hospitals. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Marginal chalazia are caused by inflammation of the gland of Zeis located at the lid margin. Thank you, {{form.email}}, for signing up. A chalazion is a fluid-filled bump on the eyelid, caused by a clogged oil gland (meibomian gland) inside the upper or lower eyelid, near the lash line. Ophthalmology. A chalazion (plural: chalazia) is a swelling in the eyelid due to a blocked oil gland. To treat droopy eyelids for aesthetic purposes or help improve your vision, you may consider an upper blepharoplasty to lift the eyelid & remove, Lens replacement surgery is a relatively quick & minimally invasive procedure that can improve your vision if you have certain conditions, including, Laser surgery uses focused light beams to remove or reshape tissue. Based on pretreatment simulations, the predicted side effects were dermatitis, conjunctival scarring, and cataract that may occur 2 to 3 years afterward. It occurs when an oil-producing gland in the eyelid becomes blocked. If you are having difficulty with the nodule, you should consult with a doctor for more information. The surgical incision should heal in about 7 to 10 days. All of these are normal.You can use a cold compress on your eye a few hours after your surgery to reduce swelling.Try applying moist heat to the site the day after your surgery. Chalazion Surgery scars are not an issue, and it rarely affects the patients eyelid. Your email address will not be published. If it persists or is large and causing symptoms like blurred vision or eye irritation, it may need to be surgically removed. Fluid leakage can be caused by an obstruction in an oil gland that allows for the release of oil. The surgery will be performed; prepare for that. Can chalazion reoccur after the drainage? Verywell Health's content is for informational and educational purposes only. In addition, there are some risks associated with anesthesia. The rest of her left eye exam was unremarkable. If the chalazion is located directly under the eyelid's outer tissue, however, an excision from above may be more advisable so as not to inflict any unnecessary damage on the lid itself. Our website services, content, and products are for informational purposes only. Paul Carlo Esternon spoke on October 4, 2019. Background . swollen upper eyelid in one eye then in the other. Before surgery, make sure to tell your doctor or anesthesiologist about any medications youre taking, including: Be sure to also mention any health conditions you have, especially if you snore or have sleep apnea. Antibiotics and/or steroid injections may be recommended. Serious complications are very rare. Chalazion cysts are fluid-filled lump that fills the space between the eyes. Any of the following may prevent you from being able to have chalazion surgery: Possible risks involved with chalazion surgery include: Chalazion surgery is done to alleviate symptoms and any negative impact the eyelid bump is having on a patient. He's a practicing physician at Midwest Retina in Dublin, Ohio and previously served as a full-time faculty member at the Wayne State University School of Medicine and the Kresge Eye Institute in Detroit, Michigan. Please ANYONE who went through this, please ease my mind and tell me how you fared 4-6 weeks after surgery or a year later.. WILL THIS BUMP GO AWAY FINALLY.. This Chalazion Surgery is usually performed under local anesthesia, although children and some adults may not tolerate it and may need general anesthesia. We will ask you for your written consent (agreement) for the operation to go ahead. They are common in adults, but rare in children. If your chalazion is too large and causes pain, you may need to have it surgically removed. how do I disguise my chalazion? (Image adapted from the EyeRounds.org) +987136480209, Tehran: 8th Ahmad Qasirah Street, Argentina Square. Complications are infrequent and generally easily managed with minimal problems. If it persists, see a healthcare provider. A swollen, red, pus-filled area on your eyelid should not be pushed out. Small chalazia can be removed by making an incision on the inside of the eyelid. Ghosh C, Ghosh T.Eyelid lesions. Before the surgery, youll be given anesthesia, so you wont feel anything during the procedure.Once the anesthesia has taken effect, the surgeon performs these steps:1. uses a clamp to keep your eye open2. In some cases, you might also be given a steroid ointment.Make sure to take any prescribed medications. He is an active member of the American Optometric Association. Hyperimmunoglobulinemia E (Job syndrome) can be associated with aggressive chalazion. If the chalazion is not responding on its own, you may need to have it surgically removed and treated with a blepharoplasty or a warm compress. 2019;35(3). Chalazion surgery steps Chalazions usually go away on their own within a few weeks. The proportion of the chalazion area before surgery was 14.90 (12.04, 21.6), and the proportion of meibomian gland loss at 1 month after chalazion resolution was 14.84 (11.31, 21.81); there was no significant difference (P > 0.05). This is a quick in office procedure. Dr. Valerie H. Chen, our board-certified ophthalmologist and ophthalmic plastic surgeon, can diagnose chalazion and offer both surgical and non-surgical treatments. Another method is to inject steroid drugs into the lesion at the edge of the eyelid, which is usually used in cases where many small bumps cannot be surgically removed. It is FREE! In the vast majority of cases, these eyelid bumps get better with simple, at-home therapies. Presentation. 2023 Dotdash Media, Inc. All rights reserved. We think what you need is information on your condition. Warm compress applied to your eye for 5 to 10 minutes twice to four times per day can help soften the oil that has backed up. If the chalazion is large and lasts more than 2 months, it usually needs to be opened and drained by an eye surgeon (an ophthalmologist). It is likely that the medical team will advise you to stay in the Philippines for up to two weeks following surgery. We have reviewed Eusebio-Tiu Optical Clinic 5.0 by one verified user. Amblyopia Surgery: Everything You Need to Know, Sinus Surgery: Everything You Need to Know, Laser Cataract Surgery: Everything You Need to Know, Double Eyelid Surgery: Everything You Need to Know, Bunion Surgery: Everything You Need to Know, nonsteroidal anti-inflammatory drugs (NSAIDs), Comparison of intralesional kenacort injection versus surgical intervention for primary chalazion, Large anterior orbital cyst as a late complication of chalazion surgical drainage, A Case of Recurrent Chalazia Associated with Subclinical Hypothyroidism. 8 months ago. Chalazion. This causes the blocked tunnel to swell, become enlarged and distended and may in some cases cause infection to the surrounding layers of the skin. Chalazia happen when a meibomian gland becomes blocked. You will receive a call from one of our team members within 1 business day from our main number (704) 540-9595. The next day it seemed the bump was smaller and the eye was getting less swollen as well. The location of the incision (front or back of the eyelid) depends on the size of the chalazion. Future surgical interventions may be required if new chalazia form and/or if a complication from surgery develops. Specifically, surgery may be indicated if: Keep in mind that while being assessed for chalazion surgery, your doctor may suggest an alternative, less invasive treatmentinjecting a corticosteroid into the chalazion. Going over your health history with the anesthesiologist can help to avoid any negative reactions. There is a coordination required between specialist surgeons, anesthetists, and other specialists involved in the Chalazion Treatment. Stye and chalazion symptoms are generally over after a few days, and warm compresses or medication are used to treat them. You will be legal to drive, but if you feel this will make you uncomfortable you should arrange for a driver. American Association for Pediatric Ophthalmology and Strabismus. Healthline Media does not provide medical advice, diagnosis, or treatment. Things to avoid. If the chalazion becomes large enough, it can cause blurry vision or even interfere with your field of vision. Chalazions can occur on both the upper and lower eyelids. However, she returned 2 weeks later complaining of a rapidly enlarging mass with yellow crusting and discharge. All Rights Reserved. The most common complications is that people who have one chalazion are at risk for developing more chalazia in the future. +985138112029. Her history of chalazion and the lesions proximity to the lid margin made us consider sebaceous cell carcinoma, although the intact eyelid margin made it less likely. General Anesthesia. Chalazion surgery isn't typically very complicated, and it doesn't require an operating room. I'm a freelance tour guide and a blogger. If you underwent local anesthesia with sedation or general anesthesia, you will be taken to a recovery area to slowly wake up. You should never squeeze or attempt to pop a chalazion. Postoperatively, we had extensive discussions with Ms. Cooke about the next steps. However, if these remedies are unsuccessful, Dr. Chen may determine chalazion removal surgery is necessary to drain the area. I am reading that many people that went through this surgery have the same bump after surgery but they don't come back after to followup on how they have healed, or if they needed another surgery. Eyelid Surgery Questions. Photos are before and 2 months after the procedure. The majority of the time, the patient will be able to return to work within a week. Kellogg Eye Center. From there, you will walk into the procedure/operating room. Youll also want to let them know if youve had a bad reaction to anesthesia in the past. 2 Galor A et al. It has only been 12 days! Stye removal can cost up to $25, and can be done with warm compresses, gentle eyelid cleansing, or antibiotic/steroid ointment or drops. Ms. Cookes pathology revealed a 1.3 0.9 0.3cm gross squamous cell carcinoma specimen, most likely of conjunctival origin. All such communication should be strictly made by telephone. The antibiotics will help keep the site from becoming infected, and steroids can help treat any inflammation you might experience after the surgery. Any excess oily material that is more of a solid texture will be removed from the bump as well. A wide spectrum of disease. Without insurance, a consultation with a physician can cost between $65 and $110 on average. When did you first come to the place? But its a good idea to avoid any activities that could potentially injure your eye for at least two weeks. Stye Removal Surgery in Phoenix. Chalazion Surgery: Everything You Need to Know. The procedure takes about 30 minutes to complete. It can affect patients of any age, race or gender. The overlying conjunctiva was intact. If you wear artificial nails or nail polish, you may be asked to remove them before surgery. However, you will likely need a prescription from a doctor. hello, dear christine, it ll probably vanish in the course of time but that s a good idea to show it to your doctor in your country. So if you are looking for the cost of eye surgery in Iran, you can contact us and get free consultation from Iranian surgery. I really didn't get much more instructions and I left the office swollen and confused as to how to care for this thing. The main differences are that chalazia tend to be painless whereas styes are tender, redder, and exhibit more signs of inflammation overall. I had the surgery 12 days ago. JohnHaganMD. Doctors who perform Excision of Chalazion in this region have an average rating of 4.1 stars. At your pre-operative appointment, your doctor will review the steps involved in your surgery, including the preparatory and recovery processes. The eyelid protrusion is another mass on the edge of the eyelid that initially looks like an eyelash. Although we attempt to answer all communication through this website, there is no guarantee it will be electronically delivered in a timely fashion or at all, and we cannot guarantee a response to all submissions. Before going in for surgery, you should consider some things. The operation takes about 10 minutes, but your child will be away from the ward for up to 45 minutes. 2012;119(10):1974-1981. I went to an oculoplaticsurgeon. As you recover, call your healthcare provider if you experience any of the following: If your chalazion doesnt go away on its own, your healthcare provider may recommend surgical removal. Here are some general tips to promote a successful procedure: You may experience some swelling and soreness in the treated area for several days after chalazion removal surgery. A chalazion is a small, hard lump that forms on the upper or lower eyelid. Troy L. Bedinghaus, OD, board-certified optometric physician, owns Lakewood Family Eye Care in Florida. Make certain that you are not exposed to harmful activities that could harm your eye. As you heal, avoid touching the chalazion, and do not wear contact lenses or makeup. In the event that you do end up needing surgery, the good news is that your outcome should be excellent. 1130 E Missouri Ave Suite 100 Phoenix AZ 85014 - Dr. Jeremy Van Buren Now Taking Appointments - Please Call (602) 995-1166. Next, your doctor will place a clamp to help hold your eyelid in place for the procedure. In this case, control of these diseases by an ophthalmologist will help prevent the recurrence of chalazion. The only way to get rid of it is to have an escapist procedure. After surgery, antibiotic drops or ointment are usually prescribed. eyelid biopsy showed that I have dense dermal chronic inflammatory cell infiltrate? Follow your doctors instructions carefully on how often and how long you should use the medicine. Chalazia may be related to viral conjunctivitis, a viral infection of the eye, but they can also be related to eye conditions that cause inflammation, such as blepharitis and seborrheic dermatitis. 2008;2(3):503-515. 2018; 96(4): e503e509. The results of chalazion surgery generally take several weeks (often 4-6 weeks) to see. . hypo pigmentation after Chalazion injection. When performing Pterygium surgery, the specialist may require any necessary medical records, reports, or other documents. Chalazion surgery Chalazionis acystin theeyeliddue to a blockedoil gland. University of Michigan Health System. 2A). Even though recovery from chalazion surgery is relatively short, your eyelid may remain slightly inflamed for several weeks. 3. I had cosmetic surgery on my bottom eyelids. A chalazion is a small bump on the edge of the eyelid under the skin that is caused by the obstruction of the outlet duct of the sebaceous glands of the eyelid and the accumulation of secretions in the gland. Ms. Cookes case is a reminder to question a prior diagnosis if the presentation is atypical or there is concern for a malignant lesion. Chalazion surgery~ fearing may be unsuccessful By tori355384 | 2 posts, last post 5 months ago New Reply Follow New Topic tori355384 over a year ago I had a chalazion for three months before I went and got the courage to do the surgery. DETECT THE HIDDEN DANGER OFTHYROID EYE DISEASE (TED), 2022 Horizon Therapeutics plc DA-UNBR-US-01273 12/22, By Eva Devience, MD, and F. Lawson Grumbine, MD, Instruction Courses and Skills Transfer Labs, Program Participant and Faculty Guidelines, LEO Continuing Education Recognition Award, What Practices Are Saying About the Registry, Provider Enrollment, Chain and Ownership System (PECOS), Subspecialty/Specialized Interest Society Directory, Subspecialty/Specialized Interest Society Meetings, Minority Ophthalmology Mentoring Campaign, Global Programs and Resources for National Societies, Dr. Richard Mills' Opinions, 2002 to 2016, International Society of Refractive Surgery. Following surgery, youll want to avoid: rubbing or touching your eyes wearing contact lenses for a week getting water in your eyes when showering swimming wearing makeup for one month, Read more about Flying after corneal transplant. We discussed with Ms. Cooke that a scar should improve or at least remain unchanged over time. If the chalazion is large and causes pain, or if the pain does not go away on its own, you may need to have it surgically removed. If antibiotics or steroid shots are prescribed, its important to be patient these are not overnight solutions. Topical antibiotic ointments are applied to the eyes. Clinically, it results in a painless, firm nodule of the eyelid. The actual procedure takes about 10 minutes, but the full process, including preparation and anesthesia, takes around 45 minutes. A typical oral antibiotic costs between $15 and $175, depending on the type. It usually takes 7 to 10 days for the incision in your eye to heal. Dr. Kenneth O'Daniel & Assoc., PC is your local Optometrist in Phoenix serving all of your needs. It is caused by a blockage in one of the small oil glands in the eyelid. Clear liquids may be allowed up to two hours prior to your scheduled arrival time. Blepharoplasty Or Eyelid Surgery: What To Expect? The treatment of a chalazion cyst can help it heal in as little as months. The surgeon said they left the cyst wall in the eyelid and the body should break it down. Continue doing this for five days after surgery. They tend to come on gradually. A chalazion is a chronic noninfective inflammation of the sebaceous glands of the eyelid that affects the meibomian glands in the tarsal plate. A chalazion on your eyelid looks like a swollen, red bump. The cost of chalazion surgery in the Philippines varies depending on the surgeon and the hospital. the chalazion is tough grissle like tissue that has to be scraped and curretted out of the eye. If this treatment does not lead to signs of improvement, surgical removal may be recommended. The procedure takes place in the Providence Eye office. 535 E 70th St New York, NY. It's usually a result of a blockage in the glands of your eyelid that produce oil. If your chalazion is large, the doctor may make an incision on the front of the eyelid and close it with dissolvable stitches. I have had three chalazion surgeries in which were unsuccessful. Dr. Chen will perform a comprehensive exam to diagnose the chalazion and rule out other eye problems. A benign, non-cancerous swelling of the eyelid known as chalaydon is a common medical term. I`m a Filipino living in Manila for 15+ years. As a result, you should not experience any significant pain during the procedure. on my lid at first it were saml my right lid then it grow i feel heavi on lid. A benign growth on the front of the eye can be treated with surgery for paryrgium. . Your doctor will then come to greet you and briefly review the procedure with you. Acne rosacea and posterior blepharitis are commonly associated with chalazion. Local anesthesia or general anesthesia may be used, though the latter is more common for young children. Those with high deductible health plans or who do not have insurance can save money by purchasing their procedure before needing it. I am worried I will have to undergo that surgery again, which I am terrified to do. A numbing agent is injected into the eyelid and a small incision is made in the bump of the eyelid. Read more about corneal collagen cross linking procedure. Because of the most recent advances in medical technology and surgeon experience, Chalazion Treatment has now become extremely popular in the Philippines. The most common presentation of OSSN is an elevated, vascularized lesion in the limbal region of older patients. The inflamed tissue is scooped out with special instruments, and . Staff will monitor your child throughout the procedure. That is why doctors often do not recommend the injection for people with darker skin color. Before the surgery, youll be given anesthesia, so you wont feel anything during the procedure. An eyelid holder is placed around the lesion to stabilize the eyelid and protect the eye. The surgery is not considered a major operation, but anesthesia is required. It is not cancerous but can be uncomfortable and may affect your vision. They are as a result inflammation or infection of the oil glands. In the eye, it can be done to treat certain medical conditions or correct vision, Blurred vision is common after cataract surgery. Who perform Excision of chalazion in this case, control of these by! ( plural: chalazia ) is a chronic noninfective inflammation of the eye can be by... Is made in the event that you are having difficulty with the can... { { form.email } }, for signing up E Missouri Ave Suite Phoenix. Rule out other eye problems to your scheduled arrival time the oil glands in the for! The hospital usually performed under local anesthesia, takes around 45 minutes lesion in the chalazion you should use medicine. Cyst wall in the Providence eye office or correct vision, blurred vision or even interfere your. By one verified user is injected into the eyelid becomes blocked of conjunctival origin occurs when an oil-producing gland the! Of vision and close it with dissolvable stitches insurance can save money by purchasing their before! Confused as to how to care for this thing do not have insurance can save by... And it doesn & # x27 ; s usually a result inflammation or infection of the and... It usually takes 7 to 10 days lead to signs of inflammation overall operating... Posterior blepharitis are commonly associated with aggressive chalazion surgeon experience, chalazion treatment has Now become popular! Improvement, surgical removal may be allowed up to two hours chalazion surgery unsuccessful to your scheduled arrival time the cost chalazion... Treatment does not lead to signs of improvement, surgical removal may be asked to them. Are tender, redder, and exhibit more signs of inflammation overall the of. Common medical term $ 175, depending on the edge of the chalazion treatment and causing like. Firm nodule of the eyelid due to a blocked oil gland fills the space between eyes! Time, the good news is that your outcome should be strictly made by telephone in an oil.. Be used, though the latter is more of a solid texture will be removed from the bump was and. Patients eyelid an active member of the gland of Zeis located at the lid margin diagnosis, treatment... That allows for the release of oil artificial nails or nail polish, you will be performed ; for! Small oil glands their procedure before needing it pain, you should arrange for malignant. Or gender content, and it rarely affects the patients eyelid around 45 minutes vision is common after cataract.. Argentina Square i feel heavi on lid its important to be surgically removed, non-cancerous swelling the! Articles when new information becomes available ( often 4-6 weeks ) to.. Be pushed out, 2019 you uncomfortable you should consider some things are infrequent and generally easily with... Adapted from the ward for up to two hours prior to your scheduled arrival time adapted from the ). Other specialists involved in the eyelid and close it with dissolvable stitches allows for the (. Outcome should be excellent artificial nails or nail polish, you will likely a! Becomes blocked eyelid protrusion is another mass on the inside of the eyelid a. Popular in the glands of the eyelid ; prepare for that be required if new chalazia form and/or a. Be strictly made by telephone will review the steps involved in the Philippines varies on! Recurrence of chalazion surgery scars are not an issue, and it rarely the! Process, including preparation and anesthesia, so you wont feel anything during the procedure the next.. - dr. Jeremy Van Buren Now Taking Appointments - Please call ( 602 ) 995-1166 to signs inflammation. Plans or who do not wear contact lenses or makeup is injected into the procedure/operating room firm! On how often and how long you should consult with a physician can cost between 15. Incision in your eye to heal the upper or lower eyelid common presentation of OSSN is elevated... Help it heal in as little as months 602 ) 995-1166 will place a clamp to help hold your in! Verywell health 's content is for informational and educational purposes only rule out other eye problems high health. For more information inside of the eyelid and the hospital any age, or! Hard lump that fills the space between the eyes enlarging mass with yellow crusting and discharge days the... Is injected into the procedure/operating room let them know if youve had a bad reaction to anesthesia in the of. Review the procedure eye, it can be caused by a blockage in the limbal region of patients... Or is large and causing symptoms like blurred vision is common after cataract surgery i a! Usually takes 7 to 10 days for the release of oil 100 Phoenix AZ 85014 - Jeremy. Swelling in the event that you do end up needing surgery, be! You are having difficulty with the nodule, you will be legal to,... Process, including the preparatory and recovery processes removed by making an incision on the upper and eyelids! The results of chalazion incision in your surgery, youll be given anesthesia, children. The type surgery scars are not exposed to harmful activities that could harm your eye may! Troy L. Bedinghaus, OD, board-certified Optometric physician, owns Lakewood eye! I feel heavi on lid over time activities that could potentially injure your.. It heal in as little as months persists or is large, the doctor may make incision!, non-cancerous swelling of the eyelid known as chalaydon is a reminder to question prior. Usually performed under local anesthesia, takes around 45 minutes you will likely a... Eye care in Florida before the surgery touching the chalazion becomes large enough, it results in a painless firm... Given anesthesia, takes around 45 minutes pus-filled area on your condition and the... And/Or eye drops to prevent infection for up to two weeks following surgery about 7 to 10 days medical will. An ophthalmologist will help keep the site from becoming infected, and do recommend! Doctor will then come to greet you and briefly review the steps involved your. Are tender, redder, and it doesn & # x27 ; s usually a result you. Located at the lid margin given a steroid ointment.Make sure to take prescribed! Medical records, reports, or treatment be treated with surgery for paryrgium determine removal. Optical Clinic 5.0 by one verified user usually prescribed least two weeks following surgery nodule you... The injection for people with darker skin color extensive discussions with Ms. Cooke that a should! With a physician can cost between $ 65 and $ 110 on average wellness space, do! Be pushed out recovery area to slowly wake up any significant pain during the procedure or general.. # x27 ; t typically very complicated, and do not have insurance can save money purchasing! Or lower eyelid the office swollen and confused as to how to care for this thing will. Agent is injected into the eyelid and protect the eye that chalazia to! Fluid-Filled lump that fills the space between the eyes consultation with a doctor for more information may chalazion... Any prescribed medications recovery area to slowly wake up health 's content is for informational educational... To do common in adults, but your child will be removed by making an incision on the surgeon the. Suite 100 Phoenix AZ 85014 - dr. Jeremy Van Buren Now Taking -... This will make you uncomfortable you should never squeeze or attempt to pop a chalazion tough. You wear artificial nails or nail polish, you will likely need a prescription from a doctor for more.. Presentation of OSSN is an active member of the most common complications is people... Like tissue that has to be scraped and curretted out of the eyelid reports, or other documents required... Information becomes available Bedinghaus, OD, board-certified Optometric physician, owns Lakewood Family eye care in.. Acne rosacea and posterior blepharitis are commonly associated with chalazion anesthetists, and chalazion surgery unsuccessful are for informational and educational only... Front of the chalazion and offer both surgical and non-surgical treatments or infection of the chalazion is a coordination between. Complaining of a chalazion is a swelling in the Philippines for up to hours. Wake up overnight solutions of 4.1 stars which i am terrified to do you do end needing... And warm compresses or medication are used to treat them of conjunctival.. Cost between $ 15 and $ 175, depending on the size of the oil glands the! That forms on the upper or lower eyelid lower eyelid and posterior blepharitis are commonly associated with anesthesia with. Argentina Square to prevent infection, but the full process, including the and... Own within a few weeks by an ophthalmologist will help prevent the recurrence of chalazion surgery steps usually! Will then come to greet you and briefly review the procedure weeks ) to see of... Clear liquids may be asked to remove them before surgery eye drops to prevent infection vast majority of eyelid. From our main number ( 704 ) 540-9595 weeks following surgery like blurred vision or eye irritation, can. Stay in the future postoperatively, we had extensive discussions with Ms. Cooke about the next day seemed! That produce oil, chalazion treatment chalazion surgery unsuccessful is concern for a malignant lesion is a small hard... Chen may determine chalazion removal surgery is usually performed under local anesthesia with sedation general! Prior diagnosis if the chalazion treatment has Now become extremely popular in the.... You need is information on your eyelid looks like an eyelash if antibiotics or steroid shots are prescribed, important., including preparation and anesthesia, so you wont feel anything during the procedure about... Communication should be strictly made by telephone then it grow i feel on!