Delta Journal of Ophthalmology

ORIGINAL ARTICLE
Year
: 2020  |  Volume : 21  |  Issue : 2  |  Page : 82--89

Effects of chalazion on corneal astigmatism and wave-front aberrations in Egyptian patients


Islam Y.S Swaify, Omar M El Zawahry, Amr A Khafagy, Shaymaa H Salah 
 Department of Ophthalmology, Kasr Al Aini Hospital, Cairo University, Cairo, Egypt

Correspondence Address:
MD Shaymaa H Salah
Department of Ophthalmology, Cairo University, 1 Saray Al-Manial, Kasr Al Aini Hospital, Al-Manial, Cairo 11559
Egypt

Abstract

Aim This study investigated the correlation between chalazion, regarding its size, site and location, and different types of refractive errors, as well as high-order aberrations in Egyptian patients. Patients and methods This is a cross-sectional study which compared 53 eyes from 48 patients having eyelid chalazion with 43 eyes of age-matched control group. Chalazion was classified according to size, site, and location. Refraction was done using an autorefractokeratometer. Corneal topography and aberrations were done using a Scheimpflug topographer. Results The third-order aberration (coma Z31) and fourth-order aberration (secondary astigmatism Z42) were higher in the chalazion group compared with the control group (P=0.035 and 0.035, respectively). Lower lid chalazia showed higher Esafoil aberration Z66 than both upper lid and control group (P=0.015 and 0.001, respectively). In addition, the large-sized chalazion group showed a significant increase in Esafoil aberration Z66 than the small-sized group and the control group (P=0.004 and 0.003, respectively). No difference was observed between the chalazion group and the control group regarding autorefractokeratometer data or topographic data. Conclusion Although the presence of chalazion may not be associated with changes in refraction or corneal astigmatism, it still can cause increase in some high-order aberrations and hence, in the quality of vision. Besides, it is a threat as a source of infection before any surgical procedure. Therefore, it is important to exclude and treat any chalazion before proceeding with any refractive surgery especially wave-front-guided and wave-front-optimized corneal refractive procedures.



How to cite this article:
Swaify IY, El Zawahry OM, Khafagy AA, Salah SH. Effects of chalazion on corneal astigmatism and wave-front aberrations in Egyptian patients.Delta J Ophthalmol 2020;21:82-89


How to cite this URL:
Swaify IY, El Zawahry OM, Khafagy AA, Salah SH. Effects of chalazion on corneal astigmatism and wave-front aberrations in Egyptian patients. Delta J Ophthalmol [serial online] 2020 [cited 2021 Dec 1 ];21:82-89
Available from: http://www.djo.eg.net/text.asp?2020/21/2/82/287462


Full Text



 Introduction



Chalazion is a localized chronic granulomatous inflammation caused by blockage of Meibomian gland ducts, more commonly affecting the upper eyelids [1]. Chalazion is the most prevalent lid disorder in Egyptian patients followed by blepharitis [2]. The range of presentation can vary from a benign, self-limiting nodule to a painful lid swelling complicated by preseptal cellulitis, mechanical ptosis, and/or amblyopia in children [1],[3]. Treatment of chalazion can be either medical by warm compresses and topical antibiotic drops and/or ointment or surgical by incision and curettage with or without intralesional steroid injection [4].

Pressure caused by a chalazion, especially large-sized chalazion in the upper eyelid, can affect the cornea inducing significant hyperopia, astigmatism, and/or topographic corneal changes [5],[6],[7]. Chalazion excision was reported to reduce corneal astigmatism and is recommended before any refractive procedure [8].

High-order aberrations (HOAs) are subtle, but of great importance as an index for improving the quality of vision [9]. There are numerous HOAs, of which only third-order aberrations, including trefoil and coma and fourth-order aberrations, including spherical and secondary astigmatism, are of clinical interest [10]. The most common method of classifying the shapes of aberrations is Zernike polynomials Znm, where n is the order of aberration and m is the angular frequency [11]. Scheimpflug imaging allows noncontact, rapid, reproducible, and quantitative measurement of refractive errors and HOAs. Scheimpflug analysis includes the anterior segment of the eye using both 360° rotating Scheimpflug camera and a 22-ring Placido’s disc. The device captures the radius of curvatures of the flat and steep meridians on 3.00 mm of the central cornea [11].

Recent studies, but few, have evaluated the effect of chalazion on corneal topography including HOAs. The relationship between the presence of chalazion and changes in refractive errors and/or corneal topography has not been thoroughly investigated, especially among the Egyptian patients. The aim of this study was to investigate the correlation between the presence of chalazia and different types of refractive errors, as well as HOAs in Egyptian patients.

 Patients and methods



The study followed the tenets of the Declaration of Helsinki and was approved as a thesis by the Ethics Committee of the Ophthalmology Department in Cairo University. The current study is a cross-sectional study which included 106 eyes of 53 patients. Patients were recruited from the Ophthalmology Outpatient Clinics in Kasr Al Ainy Hospital in the period from July 2017 till December 2017. All participants signed a written informed consent to participate in the study and for publication of data before enrollment into the study. Fifty-three eyes of 48 patients with an eyelid chalazion (43 unilateral and five bilateral) were included in the chalazion group. The control group included the contralateral normal 43 eyes of patients and 10 eyes from five age-matched normal controls.

Full personal history was taken including name, sex, age, residency, and occupation. History of the duration of chalazion and any medical treatment received was taken. Past history of any other chalazia, whether it resolved spontaneously or with medical and/or surgical treatment was asked for. Patients with a past history of surgical incision and curettage were excluded from the study. Also, patients with lens or corneal opacities were excluded from the study. The control group was completely free of any local or systemic diseases with no history of medical or surgical treatment of eyes and/or eyelids. All patients were subjected to full ophthalmological examination of both eyes in the form of lid examination with a special comment on size (measured in mm using the slit beam of the slit lamp). Patients with chalazion were divided into groups according to its size (small <5 mm diameter, medium 5–10 mm, and large >10 mm), site (upper or lower lid), and location of the chalazion (medial, middle, or lateral) at the time of presentation.

All patients and control groups underwent an automated refraction and keratometry using an autorefractokeratometer (ARK; Potec 6000 PRK; Yuseong-gu, Daejeon, South Korea). The following data were obtained: spherical error, astigmatic error and its axis, and spherical equivalent. Other data included steep keratometric value (K) in diopters (D), flat K in diopters, and average K in diopters.

Scheimpflug analysis (Sirius; Costruzione Strumenti Oftalmici, CSO, Firenze, Italy) was performed on all participants. The system provides data regarding corneal pachymetry mapping (12 mm diameter). In addition, it gives data regarding the corneal topography including the keratometric power of flat and steep meridians with the mean keratometric power, astigmatism, and axis of the steep meridian. Sometimes, we could evaluate HOAs when similar paired modes were combined into polar modes [12]. Sirius device uses the polar mode for Zernike coefficients. Analysis of corneal wave-front aberrations showed: total root mean squares, in microns, of the total HOAs and different forms of HOAs ([Table 1] and [Figure 1]).{Table 1}{Figure 1}

Statistical analysis

Data were coded and analyzed using the Statistical Package for the Social Science (SPSS Inc., Chicago, Illinois, USA), version 23. Comparisons between quantitative variables were done using Student’s t test and analysis of variance (ANOVA). Comparisons between qualitative variables were done using the c2 test. Analysis of variance, followed by post-hoc test was performed to determine differences between subgroups. All tests were two tailed and P value less than 0.05 was considered statistically significant while P value less than 0.01 was considered highly statistically significant.

 Results



The mean age was 26.21±8.68 years (range, 15–54 years) in both chalazion and control groups. The male and female percentages in both groups were 43.4 and 56.6%, respectively. The chalazion group included 53 eyes (17 right eyes and 26 left eyes) and in five patients only both eyes were involved. The median duration of chalazion was 60 days (range, 8–210 days).

Emmetropes represented 58.5% (31/53). Hypermetropia with spherical component more than +0.5 D represented 30.2% (16/53) and myopia with spherical component more than −0.5 D represented 11.3% (6/53). Astigmatism with cylindrical component more than ±0.5 represented 50.9% (27/53) ([Figure 2]).{Figure 2}

The chalazion group was divided into smaller subgroups: (a) the site of the chalazion: upper eyelid (n=33) and lower eyelid (n=20), (b) the location of the chalazion: medial third (n=13), middle third (n=17), and lateral third of the eyelid (n=23), and (c) according to the size of the chalazion: less than 5 mm in diameter (n=14), 5–10 mm (n=32), and more than 10 mm (n=7).

The ARK and corneal topography of both chalazion and control groups are shown in [Table 2]. There were no differences between the chalazion and control groups, regarding ARK data or central corneal thickness. However, third-order aberration (Coma Z31) and fourth-order aberration (secondary astigmatism Z42) were higher in the chalazion group compared with the control group (P=0.035 and 0.035, respectively, by independent t test). Other data were similar in both groups ([Table 2] and [Figure 3]). No correlation was found between the duration of chalazion and HOAs between both groups (Spearman’s correlation).{Table 2}{Figure 3}

There was no difference between the chalazion group regarding site (upper and lower) and the control group except sixth-order aberration (Esafoil Z66), which showed a significant difference between site subgroups (P=0.002, by ANOVA, [Table 3]). Lower lid chalazia showed greater Esafoil aberration Z66 than both upper lid and control group (P=0.015 and 0.001, respectively by post-hoc test).{Table 3}

There was no difference between the chalazion size subgroups (small, medium, and large) and control group except sixth-order aberration (Esafoil Z66) which showed a significant difference between this subgroup and the control group (P=0.001, by ANOVA, [Table 4]). Large-sized chalazion group showed a significant increase in Esafoil aberration Z66 than the small-sized group and the control group (P=0.004 and 0.003, respectively, by post-hoc test). There was no difference in corneal topography and aberrations between control and chalazion location subgroups (medial, lateral, or middle) ([Table 5]).{Table 4}{Table 5}

 Discussion



In this study, 58.5% of the patients with chalazia were emmetropes, 30.2% were hypermetropes and 11.3% were myopes, while 50.9% of the patients had astigmatism. These results were close to those reported in the study of Do Nascimento et al. [14], in which 58.3% of the patients (n=12) with chalazia were emmetropic, 33% were hyperopic, and 41.7% were astigmatic.

With recent advances in corneal refractive surgeries and increasing popularity of wave-front-optimized and wave-front-guided refractive procedures, proper assessment and evaluation of corneal topographic and wave-front changes associated with chalazion became of utmost importance. Chalazion excision was reported in several studies to be associated with improvement in corneal topography [15] and a decrease in HOAs especially in large chalazia bigger than 5 mm in size [7],[16]. Most of these studies only included central upper eyelid chalazia.

This study found no statistically significant difference between the chalazion group and the control group in terms of keratometric values and corneal astigmatism either by ARK or corneal topography. These results were similar to those obtained by Jin et al. [8]. However, regarding HOAs, a statistically significant difference was found in total root mean squares of total HOA, third-order aberration (Coma Z31), fourth-order aberration (secondary astigmatism Z42), and sixth-order aberration (Esafoil Z66) between the chalazion group compared with the control group. The visual effect of HOAs refers to ‘quality of vision,’ reduction of contrast sensitivity, and perception of visual disturbances such as monocular diplopia, halos, etc.

On analysis of the chalazion subgroups according to their site, size, and location, no statistically significant differences were detected between the different subgroups regarding ARK data, corneal topographic data, or wave-front data except an increase in sixth-order aberration (Esafoil aberration Z66) in the lower eyelid group (compared with both upper lid and control groups) and the large chalazion group (compared with both small-sized group and control group). Sixth-order aberration is known to be of academic purpose without any clinical impact on the quality of vision as the first four aberrations. These results are different from those reported by Jin et al [8], where greater astigmatism by simK, second-order aberration, and oblique and vertical astigmatism were found in both the upper eyelid and the large chalazion subgroups in addition to the difference between location subgroups in astigmatism by ARK, defocus, oblique astigmatism, and secondary oblique astigmatism. The difference between both studies can be attributed to the difference in the relative number of cases in each subgroup and different machines used. The absence of statistically significant differences between different subgroups in HOAs up to the fifth order in spite of the difference between the chalazion and control groups may be an indicator that such difference is not related to the size, site, or location of the chalazion. It can be explained by the duration of chalazion or alteration of the tear film structure and distribution and associated Meibomian gland disease, an assumption supported by the findings of Fukuoka et al. [17].

 Conclusion



Although the presence of chalazion may not be associated with changes in refraction or corneal astigmatism, it still can cause increase in some HOAs and, hence, in the quality of vision. Besides, it is a threat as a source of infection before any surgical procedure. It is important to exclude and treat any chalazion before proceeding with any refractive surgery, especially wave-front-guided and wave-front-optimized corneal refractive procedures.

Acknowledgements

The authors acknowledge the Laser Diagnostic and Therapeutic Unit, in Kasr Al Ainy Hospital, and Ophthalmology Department for their great efforts and help.

The study was implemented in the Laser Diagnostic and Therapeutic Unit, in Kasr Al Ainy Hospital in Cairo University.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Arbabi E, Kelly R, Carrim Z. Chalazion. BMJ 2010; 341:c4044.
2Mourad MS, Rihan RA, Mousatfa M, Mansour OAH. Prevalence of different eye diseases excluding refractive errors presented at Outpatient Clinic in Beheira Eye Hospital. Egypt J Hospital Med 2018; 71:2484–2489.
3Donaldson MJ, Gole GA. Amblyopia due to inflamed chalazion in a 13-month-old infant. Clin Exp Ophthalmol 2005; 33:332–333.
4Goawalla A, Lee V. A prospective randomized treatment study comparing three treatment options for chalazia: triamcinolone acetonide injections, incision and curettage and treatment with hot compresses. Clin Exp Ophthalmol 2007; 35:706–712.
5Santa Cruz C, Culotta T, Cohen E, Rapuano CJ. Chalazion-induced hyperopia as a cause of decreased vision. Ophthalmic Surg Lasers 1997; 28:683–684.
6Cosar CB, Rapuano CJ, Cohen EJ, Laibson PR. Chalazion as a cause of decreased vision after LASIK. Cornea 2001; 20:890–892.
7Sabermoghaddam AA, Zarei-Ghanavati S, Abrishami M. Effects of chalazion excision on ocular aberrations. Cornea 2013; 32:757–760.
8Jin KW, Shin YJ, Hyon JY. Effects of chalazia on corneal astigmatism: large-sized chalazia in middle upper eyelids compress the cornea and induce the corneal astigmatism. BMC Ophthalmol 2017; 17:173–178.
9Yamaguchi T, Negishi K, Ohnuma K, Tsubota K. Correlation between contrast sensitivity and higher-order aberration based on pupil diameter after cataract surgery. Clin Ophthalmol 2011; 5:1701–1707.
10Rapuano CJ. Basic and clinical science course, section 13: refractive surgery(2011-2012 ed). San Francisco, CA: American Academy of Ophthalmology 2011–2012;325–345.
11Cerviño A, Hosking SL, Montes-Mico R, Bates K. Clinical ocular wavefront analyzers. J Refract Surg 2007; 23:603–616.
12Campbell C. A new method for describing the aberrations of the eye using Zernike polynomials. Optom Vis Sci 2003; 80:79–83.
13Salmon TO, Pol C. Normal-eye Zernike coefficients and root-mean-square wavefront errors. J Cataract Refract Surg 2006; 32:2064–2074.
14Do Nascimento MF, Wanzeler ACV, Sousa RLF, Satto LH, Padovani CR, Schellini SA. Chalazion and demographic characteristics of patients in a population sample. Rev Bras Oftalmol 2015; 74:222–224.
15Bagheri A, Hasani HR, Karimian F, Abrishami M, Yazdani S. Effect of chalazion excision on refractive error and corneal topography. Eur J Ophthalmol 2009; 19:521–526.
16Park YM, Lee JS. The effects of chalazion excision on corneal surface aberrations. Cont Lens Anterior Eye 2014; 37:342–345.
17Fukuoka S, Arita R, Shirakawa RS, Morishige N. Changes in meibomian gland morphology and ocular higher-order aberrations in eyes with chalazion. Clin Ophthalmol 2017; 11:1031–1038.