Effects of chalazia on corneal astigmatism : Large-sized chalazia in middle upper eyelids compress the cornea and induce the corneal astigmatism

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.

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.

Corneal Epithelial Remodeling as a Cause of Chalazion-Induced Hypermetropia

PURPOSE

The importance of the corneal epithelium and its role in influencing the refractive state of the eye is well established, as is the association between periocular mass lesions, such as chalazia, and changes in corneal refractive status. This case report provides new evidence linking these 2 phenomena.

METHODS AND RESULTS

A 74-year-old man presented with gradual onset of blurred vision in his right eye. Examination revealed a large central right upper lid chalazion, with associated hypermetropic shift. Corneal topography showed central corneal flattening, and anterior segment optical coherence tomography epithelial thickness mapping showed central focal epithelial thinning. The chalazion was treated with incision and drainage and subsequent LipiFlow thermal pulsation treatment. At 3- and 4-month review, corneal epithelial thickness and topographic changes were seen to normalize, with a corresponding return toward emmetropic refractive status.

CONCLUSIONS

Chalazia can cause reversible corneal epithelial remodeling and should be considered as a differential diagnosis in cases of unexplained vision loss and changes in refractive status.

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.

Characteristics of astigmatism before and 1 month after blepharoptosis surgery in patients with acquired ptosis

In this study, we aimed to evaluate the characteristics of astigmatism preoperatively and 1 month postoperatively in patients with age-related ptosis (AP) and contact lens-related ptosis (CLP), and investigate surgery-induced astigmatism (SIA) using the Jaffe vector analysis and the Cravy method. Consecutive patients who underwent blepharoptosis surgery between January 2019 and December 2019 were included. The patients were divided into AP and CLP groups. Computerized corneal topography was used to assess the magnitude and axis of corneal astigmatism. Astigmatism was classified as with-the-rule (WTR), against-the-rule (ATR), or oblique astigmatism (OA) pre- and postoperatively. SIA was calculated by vector analysis using the Cravy and Jaffe methods. The correlation between SIA and margin reflex distance (MRD) was calculated. One hundred and eight eyes from 58 patients (AP group: 85 eyes from 45 patients, CLP group: 23 eyes from 13 patients) were included. The AP group (73.8±7.6 years) was significantly older than the CLP group (47.7±6.6 years). The MRD increased significantly after treatment in both groups. The proportions of WTR, ATR, and OA were 52%, 22%, and 25%, and 86%, 9%, and 4% in the AP and CLP groups, respectively. A shift in astigmatism type was observed in 41% and 13% of patients in the AP and CLP groups, respectively. The average SIA measured using the Cravy method was 0.11±1.22 D in the AP group and −0.28±1.07 D in the CLP group (WTR astigmatism). The SIA calculated using the Jaffe method was 0.78±0.70 D in the AP group and 0.82±0.88 D in the CLP group. There was no significant correlation between SIA calculated using the Cravy and Jaffe methods and MRD. ATR was most common in age-related ptosis and WTR was most common in contact lens-related ptosis. Upper eyelid re-positioning may affect visual functions due to astigmatic changes in the short term postoperatively.

[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.

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.

Oculoplastic considerations for refractive procedures

PURPOSE OF REVIEW

Refractive surgery is one of the most popular elective procedures performed in the world. Given that dry eye is a common complaint following keratorefractive surgery, evaluation, and treatment of periocular conditions that further predispose the patient to dry eye symptoms is an important part of the presurgical assessment. Periocular conditions and surgeries can also affect the ocular surface and keratometry, and should be addressed. For example, ptosis, orbital fat herniation, ectropion, and eyelid masses have been shown to induce corneal topography changes and astigmatism. The oculoplastic considerations for refractive surgery include both the contribution of eyelid position on dry eye, ocular surface damage, refractive error, and outcomes, as well as the timing of oculoplastic surgery in relation to the refractive surgery. In this review, the recently published literature on eyelid and orbital surgery in relation to keratorefractive surgery is reviewed to elucidate the relationship of periocular factors with refractive surgery outcomes and complications. To improve keratorefractive surgery outcomes, a literature review is presented, discussing evaluation, management, and timing of management of oculoplastics conditions.

RECENT FINDINGS

Dry eye syndrome is a well known complication of keratorefractive procedures. This is exacerbated with concurrent eyelid or orbital disorders, such as ectropion, lagophthalmos, and thyroid eye disease. In addition to impacting dry eye and ocular surface damage, eyelid surgeries can also affect corneal topography and refraction. Studies have found that patients with ptosis have topographic corneal aberrations from the eyelid exerting pressure on the cornea, while ptosis repair and blepharoplasty patients may undergo an astigmatic change postoperatively. Finally, the corneal flap created in laser-assisted in situ keratomileusis may be at risk for displacement or damage postoperatively with this risk changing, depending on method of flap creation, and time elapsed since keratorefractive surgery.

SUMMARY

Eyelid and orbital conditions that predispose to dry eye syndrome and refractive changes should be evaluated and optimized prior to keratorefractive surgery. Patients electing to have oculoplastic surgery, like ptosis repair, should be fully healed prior to any refractive surgery to allow both refractive changes and eyelid positions to stabilize prior to the refractive surgery.

Case of progressive hyperopia due to flattening of cornea

Purpose

To report a case that had a progressive decrease in the visual acuity caused by a progressive increase in the hyperopia due to a flattening of the cornea.

Observations

A 50-year-old woman complained of decreased vision in both eyes. Her decimal best-corrected visual acuity was 1.2 in the right and 0.5 in the left eyes, and the refractive error (spherical equivalent) was +3.75 diopters (D) for the right eye and +6.5 D for the left eye. Slit-lamp examinations showed clear corneas but Descemet‘s folds and fine pigmentations and opacities were present beneath the corneal epithelium in both eyes. Analysis of the corneal shape by anterior segment optical coherence tomography showed that the corneas were flattened, and the corneal refractive power was decreased in both eyes. The large values of the higher-order aberration in the cornea and total eye displayed bilateral irregular astigmatism. She obtained good vision by wearing hard contact lenses but her refractive power continued to decrease for at least 1 year.

Conclusions

and Importance: We report a rare case of progressive hyperopia and irregular astigmatism due to a flattening of the cornea. Folds were present in Descemet‘s membrane but the cornea was not edematous.