Prevalence of low serum vitamin a levels in young children with chalazia in southwest china

Age and number of lesions predict chalazion recurrence

PURPOSE

Periocular lesions in pediatric patients usually require general anesthesia for surgical intervention. The US Food and Drug Administration (FDA) warns against multiple exposures to anesthesia in children younger than 3 years due to the increased risk of learning disabilities in this population. This study aimed to evaluate risk factors associated with chalazion recurrence after surgery.

METHODS

A retrospective chart review over a five-year period identified 649 patients at our institution undergoing surgical intervention for chalazion. The primary outcomes examined were as follows: (1) return to the operating room for additional surgical intervention and (2) recurrence of chalazion during convalescence from surgery and follow-up.

RESULTS

Fewer than one-third of patients suffered a recurrence after surgery. Multivariate logistic regression found younger age (p = 0.01), female sex (p = 0.01), and a greater number of chalazia drained (p < 0.001) were significantly correlated with recurrence of chalazia after surgery.

CONCLUSIONS

Patients presenting at a younger age and with a greater number of chalazion were statistically more likely to have a recurrence of chalazion after surgery. Given recurrence is more likely in younger children, reconciling this with the risk-benefit ratio with regard to FDA guidelines on anesthesia in children under three years is a critical consideration for ophthalmologists.

Chalazion Treatment: A Concise Review of Clinical Trials

A chalazion is one of the most common eye conditions presenting as a mass lesion of the eyelids. It is seen in all age groups. Chalazion is a non-inflammatory process and develops due to retained secretion of the meibomian or Zeis glands. Treatment of choice differs among clinicians and may include application of warm compress onto eyelids, lid hygiene, using local antibiotic ointment with or without steroids, injecting steroid solution (triamcinolone acetonide) into the lesion and surgical removal of the lesion by incision and curettage. In addition, there are some other experimented methods such as injection of botulinum toxin A, tarsal trephination, removal of chalazion by application of CO2 laser or cryogenic action. However, there is currently no commonly agreed treatment of choice. In this review, we aimed to summarize findings from clinical trials and hopefully, identify a treatment of choice in chalazion.

High Load of Demodex in Young Children With Chalazia

PURPOSE

To investigate the correlation between demodicosis and pediatric chalazia.

METHODS

A case-control prospective study was conducted at Children's Hospital of Fudan University between December 2018 and January 2019. One hundred one consecutive pediatric patients with chalazia and 42 pediatric patients without chalazia underwent eyelash sampling and Demodex examination using light microscopy, and mite presence and count were documented.

RESULTS

The Demodex count and prevalence of the chalazia group was much higher than that of the control group (3.06 ± 3.48 vs 0.64 ± 1.17; P ≤ .001; 73.3% vs 35.7%, P ≤ .001). The Demodex count and prevalence of the multiple chalazia subgroup was much higher than that of the single chalazion subgroup (3.49 ± 3.72 vs 2.00 ± 2.52; P = .043; 79.2% vs 58.6%, P = .035). The Demodex count and prevalence of the chalazia with skin erosion subgroup was much higher than that of the without skin erosion subgroup (3.54 ± 3.14 vs 2.55 ± 3.76; P = .012; 82.7% vs 63.3%, P = .027). After adjustment for age and gender, Demodex count (odds ratio: 1.873; 95% confidence interval: 1.155 to 3.040; P = .011) but not presence (P = .643) was significantly correlated with chalazia.

CONCLUSIONS

Demodex mites were more prevalent and quantitative in children with chalazia, and children with severe chalazia had higher Demodex prevalence and quantity. High Demodex count rather than presence of it was associated with chalazia. [J Pediatr Ophthalmol Strabismus. 2023;60(5):365-371.].

Novel treatment of chalazion using light-guided-tip intense pulsed light

We assessed the effectiveness of light-guided-tip intense pulsed light (IPL) with meibomian gland expression (MGX) in chalazion treatment. Ninety-five eyes with chalazion received a light-guided-tip IPL-MGX treatment (IPL-MGX group), and another 95 eyes with chalazion received incision with curettage treatment (Control group). Prior to IPL or incision, as well as 1 month after the final treatment, data were gathered pertaining to the lesion location and size, hyperemia, lesions regression or recurrence, and a comprehensive ophthalmic examination. The total size of the chalazia in the IPL-MGX group was significantly reduced after the final treatment, with an average resolution rate of 70.5%, which is comparable to excision surgery. A significant decrease in chalazion recurrence rate was apparent after treatment in the IPL-MGX group compared with control. Moreover, the IPL-MGX demonstrated significant advancements throughout noninvasive tear film breakup time (NIBUT) as well as meibum grade in comparison to baseline and those in the the Control group. The use of IPL-MGX was found to be an efficient therapy for reducing the size and recurring frequency of chalazia, as well as for improving the meibomian gland function. It may be considered as a first-line treatment for cases of primary or recurrent chalazia with inflammation.

Prevalence and risk factors for chalazion in an older veteran population

BACKGROUND

Chalazia are common inflammatory eyelid lesions, but their epidemiology remains understudied. This retrospective case-control study examined the prevalence, risk factors and geographic distribution of chalazia in a large veteran population.

METHODS

Data on all individuals seen at a Veterans Affairs (VA) clinic between October 2010 and October 2015 were extracted from the VA health database. Subjects were grouped based on International Classification of Diseases, Ninth Revision (ICD-9) code for chalazion. Univariable logistic regression modelling was used to identify clinical and demographic factors associated with chalazion presence, followed by multivariable modelling to examine which factors predicted risk concomitantly. All cases were mapped across the continental US using geographic information systems modelling to examine how prevalence rates varied geographically.

RESULTS

Overall, 208 720 of 3 453 944 (6.04%) subjects were diagnosed with chalazion during the study period. Prevalence was highest in coastal regions. The mean age of the population was 69.32±13.9 years and most patients were male (93.47%), white (77.13%) and non-Hispanic (93.72%). Factors associated with chalazion risk included smoking (OR=1.12, p<0.0005), conditions of the tear film (blepharitis (OR=4.84, p<0.0005), conjunctivitis (OR=2.78, p<0.0005), dry eye (OR=3.0, p<0.0005)), conditions affecting periocular skin (eyelid dermatitis (OR=2.95, p<0.0005), rosacea (OR=2.50, p<0.0005)), allergic conditions (history of allergies (OR=1.56, p<0.0005)) and systemic disorders (gastritis (OR=1.54, p<0.0005), irritable bowel syndrome (OR=1.45, p<0.0005), depression (OR=1.35, p<0.0005), anxiety (OR=1.31, p<0.0005)). These factors remained associated with chalazion risk when examined concomitantly.

CONCLUSION

Periocular skin, eyelid margin and tear film abnormalities were most strongly associated with risk for chalazion. The impact of environmental conditions on risk for chalazion represents an area in need of further study.

Multivariate analysis of the effect of Chalazia on astigmatism in children

Background

Chalazion may affect visual acuity. This study aimed to evaluate refractive status of chalazia and effect of different sites, sizes, and numbers of chalazion on astigmatism.

Methods

Three hundred ninety-eight patients aged 0.5–6 years were divided into the chalazion group (491 eyes) and the control group (305 eyes). Chalazia were classified according to the site, size, and number. Refractive status was analyzed through the comparison of incidence, type, mean value and vector analysis.

Results

The incidence, type, refractive mean and of astigmatism in the chalazion group were higher than those in the control group, and the difference was statistically significant (P < 0.05). For comparison of the incidence, the middle-upper eyelid (50%) was highest, followed by 41.77% in the medial-upper eyelid, both higher than that in the control group (P < 0.05). In medium (54.55%) and large groups (54.76%) were higher than that in the control group (27.21%) (P < 0.05). In multiple chalazia, the astigmatism incidence for chalazion with two masses was highest (56%), much higher than that in the control group (P < 0.05). However, this difference was not significant in chalazion with ≥3 masses (P > 0.05). For comparison of the refractive mean,the medial-upper eyelid, middle-upper eyelid and medial-lower eyelid were higher than the control group (P < 0.05) (P < 0.05). The 3-5 mm and >5 mm group were higher than those in the control group and <3 mm group(P < 0.05), and the>5 mm group was larger than the 3-5 mm group，suggesting that the risk of astigmatism was higher when the size of masses > 5 mm. Astigmatism vector analysis can intuitively show the differences between groups, the results are the same as refractive astigmatism.

Conclusion

Chalazia in children can easily lead to astigmatism, especially AR and OBL. Chalazia in the middle-upper eyelid, size ≥3 mm, and multiple chalazia (especially two masses) are risk factors of astigmatism. Invasive treatment should be performed promptly if conservative treatment cannot avoid further harm to the visual acuity due to astigmatism.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-022-02529-1.

Distribution of multiple chalazia in eyelids of pediatrics requiring surgery in southeast China: a hospital-based cross-sectional study

Background

Multiple chalazia are common in children, and many are treated by surgery. However, the distribution of different types of multiple chalazia has not been studied. This research aimed to investigate the location and number of multiple chalazia in pediatrics who need surgical treatments.

Methods

Patients with multiple chalazia treated by incision and curettage surgery (I&C) in a tertiary children’s hospital between June and December 2016 were reviewed. Demographic data, locations, and numbers of chalazia were recorded. Data were analyzed using generalized linear models of the counts and the occurrences of chalazia. Hypotheses were tested using likelihood ratio tests appropriate for each type of data.

Results

The study included 128 subjects, most of which were 1–3 years old. The majority of patients had bilateral chalazia (95.3%), and the proportions of patients with internal, external, and marginal chalazion differed dramatically (99.2%, 61.7%, and 2.3%, respectively). The number of internal and external chalazia did not vary significantly with gender, age, or residence of the patients. Internal chalazia were located more frequently in the upper lids (p<0.001). External chalazia showed no preference of localization. The average number of internal chalazia in each eyelid did not relate to the presence of external chalazia.

Conclusions

Multiple chalazia are common among younger children in southeast China. The anatomical distribution varies depending on the type of chalazion. Multiple chalazia often occur bilaterally and internally. If doctors are more aware of the anatomical distribution of chalazia, this might result in a higher success rate of I&C.

Vitamin D and Ocular Diseases: A Systematic Review

The contributory roles of vitamin D in ocular and visual health have long been discussed, with numerous studies pointing to the adverse effects of vitamin D deficiency. In this paper, we provide a systematic review of recent findings on the association between vitamin D and different ocular diseases, including myopia, age-related macular degeneration (AMD), glaucoma, diabetic retinopathy (DR), dry eye syndrome (DES), thyroid eye disease (TED), uveitis, retinoblastoma (RB), cataract, and others, from epidemiological, clinical and basic studies, and briefly discuss vitamin D metabolism in the eye. We searched two research databases for articles examining the association between vitamin D deficiency and different ocular diseases. One hundred and sixty-two studies were found. There is evidence on the association between vitamin D and myopia, AMD, DR, and DES. Overall, 17 out of 27 studies reported an association between vitamin D and AMD, while 48 out of 54 studies reported that vitamin D was associated with DR, and 25 out of 27 studies reported an association between vitamin D and DES. However, the available evidence for the association with other ocular diseases, such as glaucoma, TED, and RB, remains limited.

Clinical characteristics of Demodex-associated recurrent hordeola: an observational, comparative study

Our study evaluated the association between Demodex infestation and recurrent hordeola and examined the clinical features associated with these eyelid lesions. This was an observational, comparative study. We reviewed 250 patients and divided them into the recurrent hordeolum (n = 153) and control (n = 97) groups. Demodex infestation was detected by epilating eyelashes around the lesion/s and viewing them under a light microscope. Patient medical records and photographs were retrospectively analyzed to identify the clinical characteristics of Demodex-associated recurrent hordeola. Demodex was detected in 91 (59.5%) and 17 (17.5%) patients in the recurrent hordeolum and control groups (p < 0.001), respectively. In the recurrent hordeolum group, Demodex mites were found in 74 (68.5%) and 17 (37.8%) of the adult and pediatric patients (p < 0.001), respectively. Among patients with recurrent hordeola, patients in their 20s were most likely to have concomitant Demodex infestation. Patients with Demodex infestations were also more likely to develop recurrent lesions within a shorter period of time from the primary incision and curettage. The most common presentation of Demodex-associated recurrent lesions was external hordeola (67%) (p = 0.002). Demodex infestation may cause recurrent hordeola in adults and children. These mites may play a greater role in the development of lesions in adult patients. The strongest association between Demodex infestation and recurrent lesions was seen in patients in their 20s. Our results suggest that if the hordeola recur within a short period of time with the clinical characteristics of external location of eyelid, multiple numbers of lesions, or anterior blepharitis, eyelash epilation should be performed to identify the presence of Demodex mites.

[Hordeolum and chalazion : (Differential) diagnosis and treatment]

Hordeolum and chalazion are the most frequent inflammatory eyelid tumors. They can occur in association with underlying diseases causing Meibomian gland dysfunction and/or chronic blepharitis. Due to the typical morphological features and clinical course, the diagnosis can mostly be clinically established. The majority of these lesions resolve spontaneously over time. In some instances, surgical intervention is unavoidable. In persistent, recurrent or clinically atypical cases malignant tumors must be excluded as a differential diagnosis by excisional biopsy and histopathological assessment.

The Effect of Oral Vitamin A Supplementation on Chalazion in Young Children with Vitamin A Deficiency: A Pilot Study

Purpose: Many researchers have reported that vitamin A (VA) deficiency is related to chalazion. The purpose of this article is to clarify the effects of VA supplementation on chalazion in young children with VA deficiency. Methods: Forty-eight young children with VA deficiency suffering from chalazia were enrolled from our previous studies and were followed continuously for 1 year. Serum VA levels and recurrence of chalazion were observed. Results: The mean serum VA levels increased after supplementation (P = 2.17E-15). The mean serum VA levels of subjects who experienced recurrence were lower than those without recurrence (P = 0.015). The recurrence rate and the mean recurrent frequency after supplementation were lower than before supplementation (P = 0.01, P = 6E-6); the mean time to the first recurrence of subjects without recurrence was longer after supplementation than before supplementation (P < 0.01). Conclusions: Oral VA supplementation could reduce the recurrence of chalazion in young children with preexisting VA deficiency.

Influence of Vitamin A deficiency on the transcriptomic profile of rat meibomian glands

PURPOSE

Vitamin A deficiency (VAD) is associated with chalazion in young children. However, the underlying molecular mechanism remains unclear. In the present study, transcriptome data from rat meibomian glands (MGs) were analyzed to reveal specific molecular responses to VAD.

METHODS

Total RNA was extracted and purified for library preparation and transcriptome sequencing. Differentially expressed genes (DEGs) between vitamin A normal (VAN) and VAD rats were analyzed using DESeq software. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses of DEGs were performed using the GO seq R package and KOBAS software. Real-time quantitative reverse transcription polymerase chain reaction was used to validate the RNA sequencing results.

RESULTS

The number of DEGs in the VAD group compared to the VAN group was 3129 (1531 upregulated and 1598 downregulated) in the rat MGs. VAD upregulated a large number of lipid metabolism-related genes. GO analysis showed that the most enriched and meaningful terms were related to lipid metabolism (e.g., "oxidation-reduction process, GO: 0,055,114," "lipid metabolic process, GO: 000,662"). KEGG pathway analysis showed that most of the enriched signaling pathways were involved in lipid metabolism, including the PPAR signaling pathway associated with retinoic acid (RA)-mediated nuclear receptors.

CONCLUSION

These findings demonstrate that VAD regulates the expression of numerous genes in the rat MG and that many of these genes are involved in lipid metabolic pathways.

Retrospective investigation of peripheric blood sampling in pediatric chalazion patients

PURPOSE

To compare serum thyroid hormone, vitamin B12, vitamin D3, folic acid, and ferritin levels between pediatric chalazion patients and healthy children.

METHODS

Under 18-year-old chalazion patients and age- and sex-matched healthy controls were included into this retrospective case-control study. The peripheric blood sampling results obtained within six months from ophthalmological examination were investigated for statistical analysis. Free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), vitamin B12, vitamin D3, folic acid, and ferritin levels of the chalazion and control groups were compared.

RESULTS

The male-to-female ratio was 8/28 in the chalazion group and 22/48 in the control group (p > 0.05). The mean age was 13.891 ± 3.924 years (3-17) and 12.346 ± 3.963 years (4-17) in the groups, respectively (p > 0.05). The mean time between ophthalmological examination and peripheric blood sampling was 3.012 ± 2.201 months (0-6) and 2.092 ± 1.906 months (0-6) in the groups, respectively (p > 0.05). The mean value of ferritin was 18.641 ± 8.971 μg/L (5.900-38.600) in the chalazion group and 35.455 ± 24.561 μg/L (11.850-106.100) in the control group (p = 0.019). The mean values of FT3, FT4, TSH, vitamin B12, vitamin D3, and folic acid levels were similar between the groups (p > 0.05 for all).

CONCLUSION

This study reports that pediatric chalazion patients have lower serum ferritin level than healthy children.

Serum Levels of Thyroid Hormone, Vitamin B12, Vitamin D3, Folic Acid, and Ferritin in Chalazion

PURPOSE

To compare serum thyroid hormone, vitamin B12, vitamin D3, folic acid, and ferritin levels between chalazion patients and control.

METHODS

18-65-year-old chalazion patients and controls were included. The peripheric blood sampling results were investigated. Free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), vitamin B12, vitamin D3, folic acid, and ferritin levels of chalazion and control groups were compared.

RESULTS

The male-to-female ratio was 41/107 in chalazion group and 52/106 in control group (p > .05).The mean age was 37.123 ± 13.252 years (18-65) and 39.912 ± 13.747 years (18-65) in the groups, respectively (p > .05).The mean value of vitamin B12 was 304.894 ± 131.592 pg/mL (122.700-985.300) in chalazion group and 353.200 ± 184.341 pg/mL (134.800-1127.000) in control group (p = .038).The mean values of FT3, FT4, TSH, vitamin D3, folic acid, and ferritin levels were similar between the groups (p > .05 for all).

CONCLUSION

This study reports that chalazion patients have less serum vitamin B12 level than healthy subjects.

Effects of chalazion and its treatments on the meibomian glands: a nonrandomized, prospective observation clinical study

Background

To observe the effects of chalazion and its treatments on meibomian gland function and morphology in the chalazion area.

Methods

This nonrandomized, prospective observational clinical study included 58 patients (67 eyelids) who were cured of chalazion, including 23 patients (23 eyelids) treated with a conservative method and 35 patients (44 eyelids) treated with surgery. Infrared meibomian gland photography combined with image analysis by ImageJ software was used to measure the chalazion area proportion. Slit-lamp microscopy was employed to evaluate meibomian gland function, and a confocal microscope was used to observe meibomian gland acinar morphology before treatment and 1 month after complete chalazion resolution.

Results

At 1 month after chalazion resolution, the original chalazion area showed meibomian gland loss according to infrared meibomian gland photography in both groups. In patients who received conservative treatment, the meibomian gland function parameters before treatment were 0.74 ± 0.75, 0.48 ± 0.67, and 1.22 ± 0.60, respectively. One month after chalazion resolution, the parameters were 0.35 ± 0.49, 0.17 ± 0.49, and 0.91 ± 0.60, respectively; there was significant difference (P < 0.05). The proportion of the chalazion area before treatment was 14.90 (11.03, 25.3), and the proportion of meibomian gland loss at 1 month after chalazion resolution was 14.64 (10.33, 25.77); there was no significant difference (P > 0.05). In patients who underwent surgery, the meibomian gland function parameters before surgery were 0.93 ± 0.87, 1.07 ± 0.70, and 1.59 ± 0.76, respectively, and at 1 month after chalazion resolution, they were 0.93 ± 0.82, 0.95 ± 0.75, and 1.52 ± 0.70, respectively; there was no significant difference (P > 0.05). 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). The acinar structure could not be observed clearly in the meibomian gland loss area in most patients.

Conclusions

Chalazion causes meibomian gland loss, and the range of meibomian gland loss is not related to the treatment method but to the range of chalazion itself. A hot compress as part of conservative treatment can improve meibomian gland function at the site of chalazion in the short term.

A Case of Recurrent Chalazia Associated with Subclinical Hypothyroidism

Chalazia are chronic inflammatory disorders of the Meibomian glands of the eyelids that can present at any age. Although the exact cause is still obscure, they are often associated with retention of lipids in these sebaceous glands, infections, or disturbances in the balance of sex hormones. The complications of the disease may vary from little discomfort to reduced vision. Treatment strategies include hot compresses, intralesional steroid injections, and incision and curettage. The present case is about a female in her forties with a 4-year long history of recurrent chalazia. The management of the majority of the lesions was through incision and curettage. Concomitantly she presented with subclinical hypothyroidism, for which she received treatment. During treatment of the hypothyroidism, there was a remission of the chalazia. After cessation of the treatment with levothyroxine, the chalazia started recurring. Reinstatement of a low-dose treatment with levothyroxine eventually led to a remission and prevented further recurrence of the chalazia. Subclinical hypothyroidism may predispose to recurrent chalazia. This finding may have consequences for the understanding of the pathophysiology and the management of this disorder. Further investigations must elicit the exact mechanism of this association.

Is there a relationship between low vitamin D and rotaviral diarrhea?

BACKGROUND

For children under 5 years of age, 1700 000 000 episodes of diarrhea are seen worldwide, and death occurs in 700 000 of these cases due to diarrhea. Rotavirus is an important cause of diarrhea in this age group, and many studies have shown that vitamin D plays a pivotal role in the immune system, as well as in antimicrobial peptide gene expression. In addition, lower vitamin D has been correlated with higher rates of infectious diseases such as respiratory tract infection, tuberculosis, and viral infection.

METHODS

Seventy patients with rotaviral diarrhea and 67 healthy patients were enrolled in this study. Serum 25-hydroxy vitamin D(3) (25(OH)D(3)), parathormone, calcium, phosphate, alkaline phosphatase, complete blood count parameters, and C-reactive protein were compared between pre-school children hospitalized due to rotaviral diarrhea and healthy children. Additionally, birthweight, feeding habits in the first 6 months of life, vitamin D and multivitamin supplements, and rotaviral vaccinations were also evaluated in each group.

RESULTS

There were no differences between the groups with regard to gender and age, but 25(OH)D(3) was significantly different: 14.6 ± 8.7 ng/mL in the rotaviral diarrhea patients versus 29.06 ± 6.51 ng/mL in the health controls (P < 0.001), and serum 25(OH)D(3) <20 ng/mL (OR, 6.3; 95%CI: 3.638-10.909; P < 0.001) was associated with rotaviral diarrhea.

CONCLUSIONS

Low vitamin D is associated with rotaviral diarrhea. This is the first study in the literature to show this, and this result needs to be repeated in larger controlled clinical studies.

Ophthalmic manifestations of vitamin A and D deficiency in two autistic teenagers: case reports and a review of the literature

We describe the cases of 2 autistic children with ophthalmic and systemic manifestations of vitamin A deficiency due to food faddism. Although vitamin A deficiency is common in the developing world, reports in developed societies are rare. Our patients presented over a 1-year period. The patients were 14 and 13 years old at the time of presentation and were both found to have marked features of vitamin A deficiency related to unusual dietary habits. Anterior segment signs of xerophthalmia were present in both patients. In addition, patient 1 showed evidence of a rod-predominant retinopathy, which resolved with vitamin A supplementation. Due to its rare occurrence, hypovitaminosis A must be highlighted and anticipated in this cohort.