Chalazion in children may increase risk of associated astigmatism.

Chalazion in children may increase risk of associated astigmatism. Photo: Joseph Sowka, OD. Click image to enlarge.

Chalazia are painful inflammatory events that often obscure vision as the eyelid swells. They may also induce some degree of astigmatism in children from pressure on the cornea. A recent study evaluated young children’s refractive status with chalazia and found different characteristics to be risk factors for astigmatism.

The study included 398 patients (half a year to six years old) divided into a chalazion group (n=491 eyes) and a control group (n=305 eyes). The researchers classified the chalazia by site, size and number and analyzed each patient’s refractive status.

They found that the incidence, type, astigmatism and refractive mean in the chalazion group significantly differed from the control group. Findings in affected eyes included:

  • Incidence: The middle-upper eyelid was 50% (the highest) and the medial-upper eyelid was 42%.

  • Type: There were more medium (54.5%) and large (54.7%) chalazia than in the control group (27.2%).

  • Astigmatism: With multiple chalazia, the astigmatism incidence with two masses was 56%. The difference wasn’t significant in chalazion with ≥3 masses. “Astigmatism vector analysis can intuitively show the differences between groups,” the researchers noted in their paper. “The results are the same as refractive astigmatism.”

  • Refractive mean: The medial-upper, middle-upper and medial-lower eyelid were higher than the control group. The 3mm to 5mm and >5 mm groups were higher than the control group and <3mm group. The >5mm group was larger than the 3mm to 5mm group. The researchers pointed out that this suggests “that the risk of astigmatism was higher when the size of the masses was >5mm.”

The researchers concluded that chalazia in children can easily lead to astigmatism, particularly against-the-rule astigmatism and oblique astigmatism. The identified chalazia in the middle-upper eyelid, those ≥3mm in size and multiple chalazia (especially two masses) as risk factors for astigmatism.

“Prompt invasive treatment is recommended if conservative treatment is ineffective to avoid further harm to the visual acuity due to chalazion-induced astigmatism in children,” the researchers wrote in their paper.

Ouyang L, Chen X, Pi L, et al. Multivariate analysis of the effect of chalazia on astigmatism in children. BMC Ophthalmol. July 17, 2022. [Epub ahead of print].