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Effects of chalazia on corneal astigmatism

Large-sized chalazia in middle upper eyelids compress the cornea and induce the corneal astigmatism
BMC OphthalmologyBMC series – open, inclusive and trusted201717:36

https://doi.org/10.1186/s12886-017-0426-2

Received: 19 September 2015

Accepted: 16 March 2017

Published: 31 March 2017

Abstract

Background

A chalazion is a common eyelid disease that causes eye morbidity due to inflammation and cosmetic disfigurement. Corneal topographic changes are important factors in corneal refractive surgery, intraocular lens power calculations for cataract surgery, and visual acuity assessments. However, the effects of chalazia on corneal astigmatism have not been thoroughly investigated. The changes in corneal astigmatism according to chalazion size and location is necessary for better outcome of ocular surgery. The aim of this study is to evaluate changes in corneal astigmatism according to chalazion size and location.

Methods

In this cross-sectional study, a total of 44 eyes from 33 patients were included in the chalazion group and 70 eyes from 46 patients comprised the control group. Chalazia were classified according to location and size. An autokeratorefractometer (KR8100, Topcon; Japan) and a Galilei™ dual-Scheimpflug analyzer (Ziemer Group; Port, Switzerland) were utilized to evaluate corneal changes.

Result

Oblique astigmatism was greater in the chalazion group compared with the control group (p < 0.05). Astigmatism by simulated keratometry (simK), steep K by simK, total root mean square, second order aberration, oblique astigmatism, and vertical astigmatism were significantly greater in the upper eyelid group (p < 0.05). Astigmatism by simK, second order aberration, oblique astigmatism, and vertical astigmatism were significantly greater in the large-sized chalazion group (p < 0.05). Corneal wavefront aberration was the greatest in the upper eyelid chalazion group, whole area group, and large-sized chalazion group (p < 0.05).

Conclusions

Large-sized chalazia in the whole upper eyelid should be treated in the early phase because they induced the greatest change in corneal topography. Chalazion should be treated before corneal topography is performed preoperatively and before the diagnosis of corneal diseases.

Keywords

ChalaziaAstigmatismWavefrontCorneal topography

Background

A chalazion is a meibomian gland lipogranuloma which accompanies swelling on the eyelid and eyelid tenderness [1]. It is a common eyelid disease that causes eye morbidity due to inflammation and cosmetic disfigurement [2]. A variety of factors are believed to be associated with the development of chalazia including meibomian gland dysfunction, chronic blepharitis, seborrheic dermatitis, gastritis, and smoking [1]. Chalazia treatment includes medical treatments, such as warm compression and topical antibiotic eye drops or ointment, and surgical incision and curettage, with or without triamcinolone intralesional injection [3].

Corneal topographic changes are important factors in corneal refractive surgery, intraocular lens power calculations for cataract surgery, and visual acuity assessments [46]. In addition, amblyopia may develop in children with corneal astigmatism [7]. It has been reported that the pressure of an upper lid chalazion induces hyperopia and astigmatism.7 Chalazia can increase higher-order aberrations (HOAs), as measured by the Hartmann–Shack aberrometer; these can affect the preoperative evaluation and refractive surgery outcomes, especially wavefront-guided approaches [8]. In addition, decreased vision due to a chalazion of the upper eyelid has been documented in a patient following laser-assisted in situ keratomileusis (LASIK) [9]. Furthermore, corneal aberration has been reported to contribute to the visual function [10, 11]. The changes in corneal astigmatism according to chalazion size and location is necessary for better outcome of ocular surgery.

However, the effects of chalazia on corneal astigmatism have not been thoroughly investigated. In this study, we investigated changes in corneal astigmatism according to chalazion size and location.

Methods

This study adhered to the tenets of the Declaration of Helsinki and was approved by the Institutional Review Board of Hallym University Medical Center. Medical charts of a total of 114 eyes from 64 patients were reviewed retrospectively in this study between July 2013 and April 2015 at the Hallym University Gangnam Sacred Heart Hospital, Seoul, South Korea. Forty four eyes from 33 patients exhibiting an eyelid chalazion were assigned to the chalazion group. The control group comprised 22 contralateral normal eyes of chalazion patients and 48 eyes from 24 patients without a chalazion, randomly selected and matched for age and sex. Patient medical history including diabetes mellitus and hypertension was obtained and a physical examination of eye and eyelid was performed prior to study procedures. Patients in the control group did not have a history of ophthalmic surgery including eyelid surgery and were not using topical or systemic medications on examination.

Chalazia were classified according to their site (upper, lower, or both eyelid groups) and location (nasal, middle, temporal, or whole area of eyelid). They also were classified into groups according to their size; small (≤1/5 of eyelid), medium (2/5–3/5), or large (>4/5).

An autokeratorefractometer (ARK; KR8100, Topcon; Japan) was utilized to measure keratometric values (K) including mean K, flat and steep K, astigmatism, and axis. Central corneal thickness (CCT), corneal topographic data, and wavefront aberration data were obtained using a Galilei™ dual-Scheimpflug analyzer (Ziemer Group; Port, Switzerland). Simulated K (simK) were obtained from the central 3-mm zone of the corneas including flat and steep K, mean K, astigmatism (difference between steep and flat Ks), and the axis of the steep meridian.

Corneal wavefront aberrations were analyzed, including total root mean square (RMS, in microns) of the total high order aberration, second order aberration, oblique astigmatism (Z−2 2), defocus (Z0 2), vertical astigmatism (Z2 2), third order aberration, vertical trefoil (Z−3 3), vertical coma (Z−1 3), horizontal coma (Z1 3), oblique trefoil (Z3 3), fourth order aberration, oblique quadrefoil (Z−4 4), secondary oblique astigmatism (Z−2 4), primary spherical aberration (Z0 4), vertical secondary astigmatism (Z2 4), and vertical quadrefoil (Z4 4).

Statistical analysis

All statistical analyses were performed using SPSS v.18.0 (IBM Corp., NY, USA). An independent t-test was used to compare the outcomes between the chalazion and control groups. Analysis of variance, followed by Tukey post hot test, was performed to determine differences between subgroups.

Results

A total 114 eyes from 64 patients were included in this study: 44 eyes in the chalazion group and 70 eyes in the control group (Table 1). Mean patient age was 40.0 ± 13.9 years in the chalazion group and 43.4 ± 14.0 years in the control group. The chalazion group was divided into the following subgroups: 1) according to site of the chalazion, the upper eyelid (n = 22), lower eyelid (n = 16), and both eyelids (n = 6), 2) according to the location of the chalazion, the nasal eyelid (n = 10), middle eyelid (n = 25), temporal eyelid (n = 4), and whole eyelid (n = 3), and 3) according to the size of the chalazion, small (n = 14), medium (n = 17), and large (n = 11) (Additional file 1).
Table 1

Demographic data of subjects

 

N

Control

70

Chalazion group

44

Site

 Upper eyelid

22

 Lower eyelid

16

 Both eyelid

6

Location

 Nasal

10

 Middle

25

 Temporal

4

 Whole

3

Size

 Small

14

 Medium

17

 Large

11

Corneal topographic data for the chalazion and control groups are presented in Fig. 1 and Table 2. There was no difference in CCT different between the two groups. Astigmatism measured by ARK was not significantly different between the chalazion and control groups (p = 0.074; independent t-test). Oblique astigmatism (Z−2 2) was greater in the chalazion group compared with the control group (p = 0.013; independent t-test). Other topographic data were similar between the chalazion and control groups.
Fig. 1

Corneal topographic data for the chalazion and control groups. Simulated K (simK; (a) and astigmatism by simK (b) is similar between the two groups. Oblique astigmatism (Z−2 2; c) is greater in the chalazion group compared with the control group (p = 0.013; independent t-test)

Table 2

Corneal topographic data between chalazion and control group

 

Total

Chalazion group

Control group

p-value

N (eyes)

114

44

70

 

Gender (M:F)

52:62

19:25

33:37

 

Age (year)

41.59 ± 14.08

39.57 ± 13.83

42.86 ± 14.18

0.226

CCT (μm)

547.25 ± 39.90

546.91 ± 43.64

547.46 ± 37.69

0.943

Average keratometry by ARK (D)

42.96 ± 1.86

42.84 ± 2.08

43.03 ± 1.72

0.603

Astigmatism by ARK (D)

-0.85 ± 0.99

−0.94 ± 1.44

−0.79 ± 0.58

0.546

Axis by ARK (°)

104.23 ± 63.36

108.63 ± 60.74

101.48 ± 65.26

0.579

SimK (D)

42.76 ± 3.49

42.43 ± 2.28

42.96 ± 4.08

0.434

Astigmatism by simK (D)

1.31 ± 0.96

1.53 ± 1.16

1.17 ± 0.78

0.074

Axis by simK (°)

84.74 ± 35.24

85.16 ± 28.23

84.47 ± 39.20

0.914

Mean K of posterior surface (D)

−6.28 ± 0.27

−6.25 ± 0.24

−6.29 ± 0.28

0.514

Astigmatism of posterior surface (D)

−0.44 ± 0.29

−0.46 ± 0.26

−0.43 ± 0.32

0.691

Total RMS (μm)

1.81 ± 0.80

1.97 ± 1.05

1.71 ± 0.59

0.127

2nd order aberration (μm)

1.55 ± 0.70

1.68 ± 0.87

1.48 ± 0.55

0.184

Oblique astigmatism (Z−2 2; μm)

0.04 ± 0.49

0.18 ± 0.52

−0.05 ± 0.45

0.013*

Defocus (Z0 2; μm)

−0.85 ± 0.50

−0.83 ± 0.53

−0.87 ± 0.49

0.693

Vertical astigmatism (Z2 2; μm)

−0.74 ± 1.06

−0.98 ± 1.16

−0.59 ± 0.98

0.057

3rd order aberration (μm)

0.67 ± 0.42

0.71 ± 0.53

0.64 ± 0.34

0.398

Vertical trefoil (Z−3 3; μm)

−0.18 ± 0.40

−0.24 ± 0.44

−0.14 ± 0.37

0.216

Vertical Coma (Z−1 3; μm)

0.34 ± 3.01

0.13 ± 0.37

0.48 ± 3.84

0.555

Horizontal coma (Z1 3; μm)

−0.04 ± 0.31

−0.04 ± 0.29

−0.04 ± 0.33

0.961

Oblique trefoil (Z3 3; μm)

−0.02 ± 0.44

−0.06 ± 0.55

−0.01 ± 0.35

0.378

4th order aberration (μm)

0.40 ± 0.30

0.40 ± 0.30

0.40 ± 0.30

0.921

Oblique quadrefoil (Z−4 4; μm)

0.01 ± 0.09

0.02 ± 0.10

0.00 ± 0.07

0.293

Oblique secondary astigmatism (Z−2 4; μm)

0.01 ± 0.13

−0.01 ± 0.14

0.01 ± 0.11

0.333

Primary spherical (Z0 4; μm)

0.17 ± 0.30

0.17 ± 0.32

0.16 ± 0.30

0.922

Vetical secondary astigmatism (Z2 4; μm)

0.07 ± 0.18

0.05 ± 0.19

0.08 ± 0.18

0.447

Vertical quadrefoil (Z4 4; μm)

−0.11 ± 0.23

−0.11 ± 0.22

−0.12 ± 0.24

0.888

SimK simulated keratometry, ARK autorefractokeratometry, RMS root mean square, D diopter; *Statistically significant by independent t-test

The CCT was not significantly different between the chalazion site subgroups (Fig. 2, Table 3). However, astigmatism by simK, steep K by simK, total RMS, second order aberration, Z−2 2, and Z2 2 were significantly different between these subgroups (p = 0.001, 0.022, 0.002, <0.001, 0.009, and 0.001, respectively; ANOVA). Astigmatism by simK was greater in the upper eyelid group compared with the control and lower eyelid groups (p = 0.001 and 0.004, respectively; Tukey post hoc test). Steep K by simK significantly differed between upper and lower lids (p = 0.011; Tukey post hoc test). Total RMS was greater in the upper eyelid group compared with the control and lower eyelid groups (p = 0.004 and 0.003, respectively; Tukey post hoc test). Second order aberration was greater in the upper eyelid group compared with the control, lower eyelid, and whole eyelid groups (p = 0.001, <0.001, and 0.019, respectively; Tukey post hoc test). The Z−2 2 was greater in the upper eyelid group compared with the control (p = 0.06, Tukey post hoc test). The Z2 2 was greater in the upper eyelid group compared with the control and lower eyelid group, and lower in the upper eyelid group compared with whole eyelid group (p = 0.002, 0.008 and, 0.028, respectively; Tukey post hoc test).
Fig. 2

Corneal topographic data according to the site of chalazion. Chalazia are classified into control, upper, lower, or both eyelid group. Astigmatism by simulated keratometry (simK; (a), steep keratometry (K) by simK (b), total root mean square (RMS; c), second order aberration (d), oblique astigmatism (Z−2 2; e), and vertical astigmatism (Z2 2; f) are significantly different between the subgroups (p = 0.001, 0.022, 0.002, < 0.001, 0.009, and 0.001, respectively; one-way analysis of variance)

Table 3

Corneal topographic data according to site of chalazion

 

Control

Upper eyelid

Lower eyelid

Both eyelids

p-value

n

70

22

16

6

 

Gender (M:F)

33:37

10:12

3:13

6:0

 

Age (year)

42.86 ± 14.18

41.27 ± 12.41

38.63 ± 16.74

35.83 ± 11.16

0.519

CCT (μm)

547.46 ± 37.69

5583.27 ± 42.50

528.25 ± 45.57

555.00 ± 28.33

0.136

Average keratometry by ARK (D)

43.03 ± 1.72

43.38 ± 1.69

42.18 ± 2.58

42.82 ± 1.44

0.269

Astigmatism by ARK (D)

-0.79 ± 0.58

−1.12 ± 1.93

−0.88 ± 0.85

−0.50 ± 0.45

0.490

Axis by ARK (°)

101.48 ± 65.26

118.16 ± 67.99

102.50 ± 53.94

92.00 ± 57.73

0.750

SimK (D)

42.96 ± 4.08

43.11 ± 1.69

41.51 ± 2.99

42.42 ± 1.21

0.470

Astigmatism by simK (D)

1.17 ± 0.78

2.01 ± 1.27

0.98 ± 0.59

1.23 ± 1.26

0.001*

Axis by simK (°)

84.47 ± 39.20

83.05 ± 25.31

88.31 ± 27.04

84.50 ± 43.78

0.470

Mean K of posterior surface (D)

−6.29 ± 0.28

−6.29 ± 0.29

−6.24 ± 0.15

−6.16 ± 0.25

0.653

Astigmatism of posterior surface (D)

−0.43 ± 0.32

−0.53 ± 0.32

−0.36 ± 0.13

−0.42 ± 0.16

0.336

Total RMS (μm)

1.71 ± 0.59

2.35 ± 1.13

1.46 ± 0.39

1.96 ± 1.47

0.002*

2nd order aberration (μm)

1.48 ± 0.55

2.11 ± 1.04

1.23 ± 0.31

1.24 ± 0.20

<0.001*

Oblique astigmatism (Z−2 2; μm)

−0.05 ± 0.45

0.33 ± 0.57

−0.03 ± 0.40

0.21 ± 0.43

0.009*

Defocus (Z0 2; μm)

−0.87 ± 0.49

−0.79 ± 0.72

−0.82 ± 0.25

−0.99 ± 0.10

0.820

Vertical astigmatism (Z2 2; μm)

−0.59 ± 0.98

−1.55 ± 1.28

−0.48 ± 0.69

−0.25 ± 0.62

0.001*

3rd order aberration (μm)

0.64 ± 0.34

0.85 ± 0.68

0.55 ± 0.17

0.62 ± 0.43

0.129

Vertical trefoil (Z−3 3; μm)

−0.14 ± 0.37

−0.28 ± 0.54

−0.16 ± 0.21

−0.31 ± 0.50

0.470

Vertical Coma (Z−1 3; μm)

0.48 ± 3.84

0.23 ± 0.41

−0.02 ± 0.31

0.18 ± 0.30

0.939

Horizontal coma (Z1 3; μm)

−0.04 ± 0.33

−0.025 ± 0.29

−0.13 ± 0.31

0.13 ± 0.15

0.398

Oblique trefoil (Z3 3; μm)

−0.01 ± 0.35

−0.16 ± 0.72

−0.01 ± 0.28

0.14 ± 0.30

0.332

4th order aberration (μm)

0.40 ± 0.30

0.44 ± 0.21

0.39 ± 0.40

0.30 ± 0.27

0.802

Oblique quadrefoil (Z−4 4; μm)

0.00 ± 0.07

0.03 ± 0.14

0.02 ± 0.05

−0.02 ± 0.03

0.422

Oblique secondary astigmatism (Z−2 4; μm)

0.01 ± 0.11

−0.02 ± 0.16

−0.00 ± 0.11

0.03 ± 0.15

0.618

Primary spherical (Z0 4; μm)

0.16 ± 0.30

0.10 ± 0.23

0.29 ± 0.43

0.11 ± 0.09

0.243

Vetical secondary astigmatism (Z2 4; μm)

0.08 ± 0.18

0.10 ± 0.21

−0.01 ± 0.16

0.02 ± 0.06

0.230

Vertical quadrefoil (Z4 4; μm)

−0.12 ± 0.24

−0.13 ± 0.25

−0.07 ± 0.11

−0.15 ± 0.33

0.876

SimK simulated keratometry, ARK autorefractokeratometry, RMS root mean square, D diopter; Results were presented as mean ± standard deviation

*Statistically significant by ANOVA

Corneal topographic changes according to chalazion location are presented in Fig. 3 and Table 4. The CCT was also not significantly different between chalazion location subgroups. Astigmatism by ARK, Z−2 2, Z0 2, and Z−2 4 were significantly different between groups (p = 0.046, 0.033, 0.003, and 0.015, respectively; ANOVA). Astigmatism by ARK was significantly different between the control and temporal area groups or between middle and temporal area group (p = 0.019 and 0.025; Tukey post hoc test). The Z0 2 was greater in the whole area group compared with the control, nasal, middle, and temporal area groups (p = 0.002, 0.021, 0.001, and 0.004, respectively; Tukey post hoc test). There was a significant difference in Z−2 4 between temporal and whole area groups (p = 0.018; Tukey post hoc test).
Fig. 3

Corneal topographic changes according to the chalazion location. Chalazia are classified into control, nasal, middle, temporal, or whole area group. Astigmatism by auto-refractokeratometer (a), oblique astigmatism (Z−2 2; b), defocus (Z0 2; c), and secondary oblique astigmatism (Z−2 4; d) are significantly different between groups (p = 0.046, 0.033, 0.003, and 0.015, respectively, one-way analysis of variance)

Table 4

Corneal topographic changes according to chalazion location

 

Control

Nasal

Middle

Temporal

Whole

p-value

n

70

10

25

4

3

 

Gender (M:F)

33:37

5:5

9:16

2:2

2:1

 

Age (year)

42.86 ± 14.18

42.20 ± 16.29

38.12 ± 13.66

43.75 ± 14.48

45.67 ± 4.51

0.679

CCT (μm)

547.46 ± 37.69

550.50 ± 19.60

542.16 ± 50.65

542.25 ± 32.40

552.33 ± 14.05

0.952

Average keratometry by ARK (D)

43.03 ± 1.72

42.44 ± 1.71

42.83 ± 2.35

44.79 ± 1.51

42.51 ± 0.88

0.411

Astigmatism by ARK (D)

-0.79 ± 0.58

−0.93 ± 1.01

−0.79 ± 58.50

−2.58 ± 3.19

−0.75 ± 0.35

0.046*

Axis by ARK (°)

101.48 ± 65.26

108.89 ± 61.53

115.00 ± 58.50

126.67 ± 70.77

105.00 ± 49.50

0.851

SimK (D)

42.96 ± 4.08

41.96 ± 1.91

42.33 ± 2.59

43.47 ± 1.62

43.86 ± 2.15

0.823

Astigmatism by simK (D)

1.17 ± 0.78

1.16 ± 1.14

1.54 ± 1.13

1.61 ± 1.79

2.30 ± 0.56

0.143

Axis by simK (°)

84.47 ± 39.20

80.00 ± 33.72

82.92 ± 27.77

103.00 ± 29.06

92.00 ± 22.54

0.843

Mean K of posterior surface (D)

−6.29 ± 0.28

−6.19 ± 0.20

−6.24 ± 0.24

−6.40 ± 0.34

−6.42 ± 0.37

0.543

Astigmatism of posterior surface (D)

−0.43 ± 0.32

−0.43 ± 0.13

−0.45 ± 0.32

−0.46 ± 0.19

−0.58 ± 0.13

0.942

Total RMS (μm)

1.71 ± 0.59

1.64 ± 0.76

2.03 ± 1.14

2.09 ± 1.48

2.37 ± 1.05

0.243

2nd order aberration (μm)

1.48 ± 0.55

1.35 ± 0.78

1.69 ± 0.82

1.90 ± 1.53

2.14 ± 0.93

0.219

Oblique astigmatism (Z−2 2; μm)

−0.05 ± 0.45

0.06 ± 0.48

0.17 ± 0.49

0.44 ± 0.82

0.58 ± 0.47

0.033*

Defocus (Z0 2; μm)

−0.87 ± 0.49

−0.75 ± 0.34

−0.94 ± 0.15

−1.09 ± 0.06

0.22 ± 1.80

0.003*

Vertical astigmatism (Z2 2; μm)

−0.59 ± 0.98

−0.56 ± 1.11

−1.00 ± 1.19

−1.18 ± 1.68

−1.51 ± 0.54

0.269

3rd order aberration (μm)

0.64 ± 0.34

0.65 ± 0.36

0.75 ± 0.66

0.67 ± 0.19

0.71 ± 0.30

0.877

Vertical trefoil (Z−3 3; μm)

−0.14 ± 0.37

−0.27 ± 0.40

−0.31 ± 0.47

−0.01 ± 0.24

0.11 ± 0.51

0.212

Vertical Coma (Z−1 3; μm)

0.48 ± 3.84

0.18 ± 0.24

0.16 ± 0.41

−0.12 ± 0.39

0.10 ± 0.46

0.986

Horizontal coma (Z1 3; μm)

−0.04 ± 0.33

−0.07 ± 0.26

−0.05 ± 0.28

0.15 ± 0.47

0.00 ± 0.24

0.820

Oblique trefoil (Z3 3; μm)

−0.01 ± 0.35

−0.12 ± 0.42

−0.13 ± 0.64

0.29 ± 0.19

0.10 ± 0.24

0.349

4th order aberration (μm)

0.40 ± 0.30

0.43 ± 0.20

0.38 ± 0.34

0.36 ± 0.07

0.56 ± 0.50

0.885

Oblique quadrefoil (Z−4 4; μm)

0.00 ± 0.07

0.03 ± 0.14

0.03 ± 0.10

0.01 ± 0.01

−0.05 ± 0.06

0.380

Oblique secondary astigmatism (Z−2 4; μm)

0.01 ± 0.11

−0.03 ± 0.12

−0.02 ± 0.12

0.15 ± 0.12

−0.14 ± 0.16

0.015*

Primary spherical (Z0 4; μm)

0.16 ± 0.30

−0.03 ± 0.12

−0.02 ± 0.12

0.20 ± 0.14

−0.11 ± 0.50

0.590

Vetical secondary astigmatism (Z2 4; μm)

0.08 ± 0.18

0.17 ± 0.26

0.20 ± 0.34

−0.03 ± 0.15

0.12 ± 0.41

0.754

Vertical quadrefoil (Z4 4; μm)

−0.12 ± 0.24

0.03 ± 0.25

0.05 ± 0.12

0.01 ± 0.20

−0.18 ± 0.39

0.710

SimK simulated keratometry, ARK autorefractokeratometry, RMS root mean square, D diopter; Results were presented as mean ± standard deviation.; *Statistically significant by ANOVA

Corneal topographic changes according to chalazion size are presented in Fig. 4 and Table 5. The CCT was not significantly different between chalazion size subgroups. Astigmatism by simK, second order aberration, Z−2 2, and Z2 2 were greater in the large-sized chalazion group (p = 0.037, 0.036, 0.006, and 0.002, respectively; ANOVA). Astigmatism by simK and second order aberration was greater in the large-sized chalazion group compared with the control (p = 0.049 for both; Tukey post hoc test). There was a significantly greater Z−2 2 in the large-sized chalazion group compared with the control (p = 0.003; Tukey post hoc test). Z2 2 was greater in the large-sized chalazion group compared with the control and small-sized chalazion groups (p = 0.015 and 0.004, respectively; Tukey post hoc test).
Fig. 4

Corneal topographic changes according to chalazia size. Chalazia are classified into control, small-, medium- or large-sized groups. Astigmatism by simulated keratometry (simK; a), second order aberration (b), oblique astigmatism (Z-2 2; c), and vertical astigmatism (Z2 2; d) are significantly greater in the large-sized chalazion group (p = 0.037, 0.036, 0.006, and 0.002, respectively; one-way analysis of variance)

Table 5

Corneal topographic changes according to chalazion size

 

Control

Small

Medium

Large

p-value

n

70

14

17

11

 

Gender (M:F)

33:37

5:9

6:11

7:4

 

Age (year)

42.86 ± 14.18

43.64 ± 19.08

38.47 ± 10.72

38.36 ± 10.00

0.543

CCT (μm)

547.46 ± 37.69

539.29 ± 27.84

555.29 ± 34.43

535.91 ± 60.86

0.526

Average keratometry by ARK (D)

43.03 ± 1.72

43.66 ± 1.01

42.71 ± 2.11

42.09 ± 2.96

0.224

Astigmatism by ARK (D)

-0.79 ± 0.58

−0.85 ± 0.88

−0.89 ± 1.67

−1.20 ± 1.82

0.688

Axis by ARK (°)

101.48 ± 65.26

108.33 ± 50.24

113.75 ± 66.37

121.00 ± 55.42

0.714

SimK (D)

42.96 ± 4.08

43.07 ± 1.11

42.23 ± 2.30

42.05 ± 3.41

0.767

Astigmatism by simK (D)

1.17 ± 0.78

1.05 ± 0.67

1.69 ± 1.43

1.82 ± 1.13

0.037*

Axis by simK (°)

84.47 ± 39.20

89.93 ± 39.47

80.76 ± 26.52

84.45 ± 13.91

0.917

Mean K of posterior surface (D)

−6.29 ± 0.28

−6.23 ± 0.19

−6.25 ± 0.27

−6.30 ± 0.29

0.858

Astigmatism of posterior surface (D)

−0.43 ± 0.32

−0.34 ± 0.12

−0.54 ± 0.36

−0.48 ± 0.14

0.322

Total RMS (μm)

1.71 ± 0.59

1.77 ± 0.96

1.90 ± 1.05

2.33 ± 1.24

0.113

2nd order aberration (μm)

1.48 ± 0.55

1.34 ± 0.37

1.68 ± 1.04

2.06 ± 1.00

0.036*

Oblique astigmatism (Z−2 2; μm)

−0.05 ± 0.45

0.09 ± 0.48

0.09 ± 0.50

0.49 ± 0.55

0.006*

Defocus (Z0 2; μm)

−0.87 ± 0.49

−0.89 ± 0.31

−0.94 ± 0.15

−0.56 ± 0.96

0.222

Vertical astigmatism (Z2 2; μm)

−0.59 ± 0.98

−0.20 ± 0.87

−1.15 ± 1.21

−1.60 ± 1.01

0.002*

3rd order aberration (μm)

0.64 ± 0.34

0.63 ± 0.30

0.64 ± 0.44

0.94 ± 0.84

0.169

Vertical trefoil (Z−3 3; μm)

−0.14 ± 0.37

−0.24 ± 0.34

−0.23 ± 0.43

−0.26 ± 0.60

0.691

Vertical Coma (Z−1 3; μm)

0.48 ± 3.84

0.01 ± 0.37

0.18 ± 0.42

0.22 ± 0.30

0.947

Horizontal coma (Z1 3; μm)

−0.04 ± 0.33

−0.11 ± 0.32

0.03 ± 0.24

−0.01 ± 0.33

0.632

Oblique trefoil (Z3 3; μm)

−0.01 ± 0.35

−0.04 ± 0.28

−0.02 ± 0.35

−0.19 ± 0.98

0.619

4th order aberration (μm)

0.40 ± 0.30

0.29 ± 0.18

0.38 ± 0.21

0.58 ± 0.45

0.094

Oblique quadrefoil (Z−4 4; μm)

0.00 ± 0.07

0.04 ± 0.12

−0.00 ± 0.05

0.05 ± 0.14

0.296

Oblique secondary astigmatism (Z−2 4; μm)

0.01 ± 0.11

0.01 ± 0.13

−0.02 ± 0.11

−0.06 ± 0.17

0.264

Primary spherical (Z0 4; μm)

0.16 ± 0.30

0.10 ± 0.09

0.20 ± 0.26

0.22 ± 0.54

0.739

Vetical secondary astigmatism (Z2 4; μm)

0.08 ± 0.18

0.05 ± 0.16

0.03 ± 0.19

0.06 ± 0.22

0.840

Vertical quadrefoil (Z4 4; μm)

−0.12 ± 0.24

−0.09 ± 0.18

−0.09 ± 0.21

−0.15 ± 0.31

0.903

SimK simulated keratometry, ARK autorefractokeratometry, RMS root mean square, D diopter; Results were presented as mean ± standard deviation.; *Statistically significant by ANOVA

Discussion

A chalazion is a common eyelid disease, affecting individuals of all ages, caused by plugged meibomian glands and chronic lipogranulomatous inflammation [12]. Chalazia have been reported to increase corneal astigmatism and HOAs [7, 8, 13, 14]. In this study, we evaluated the effects of chalazia on the cornea according to chalazia site, location, and size using corneal topography and wavefront analysis. This study systematically revealed the mechanical effects of chalazia on corneal astigmatism. In this study, a large-sized chalazion in the whole upper eyelid induced changes in the corneal topographical and wavefront assessments. The mechanisms behind the effects of chalazia on corneal astigmatism can be suggested as follow. Firstly, with regards to the biomechanical properties of the cornea, it has been reported that its tensile strength is 3.81 ± 0.40 MPa and its stress-strain is α = 42.81 ± 11.67 and β = 2.97 ± 0.21 [15]. Compressive pressure of chalazia in excessive of these levels can induce the corneal astigmatism. In contrast, cornea under reduced strain by corneal refractive surgery (such as LASIK) may be more affected by lower pressure [9]. Secondly, lamellar orientation in human corneas has been shown to be related to mechanical properties [16, 17]. The mechanical effects increase in the meridian direction as they become closer to the center of the cornea [17]. Variations in the regional elastic performance of the human cornea have been reported; the pressure-induced meridional strains were smallest at the corneal paracenter and periphery, with the largest recorded at the limbus [18]. The circumferential strains varied less between regions with the para-centre straining to the greatest extent. In the meridional direction, Young’s modulus of elasticity was greatest at the central and para-central corneal regions, while the greatest circumferential elastic modulus was found at the limbus [17, 18]. Some authors have suggested the notion of circumferentially orientated reinforcing structures in human limbal tissue [18]. The para-central region of the human cornea was found to be stiffer in the meridional direction compared with the circumferential direction, suggesting a meridionally-orientated reinforcement of the para-central parts of the human cornea [18]. Furthermore, the human corneal stroma exhibit a preferred collagen orientation in the inferior-superior and nasal-temporal directions. However, at the limbus, the preferred orientation is tangential to the cornea [19]. Therefore, it is difficult for the pressure on the sclera to have an effect on the cornea in the meridian direction. Chalazia in the middle eyelid can more easily induce corneal astigmatism in the meridian direction because it is located superior to the cornea and close to the center of the cornea. The mass effect of a chalazion could increase with size. Chalazia generally affected Z−2, an aberration of off-axis rays. Furthermore, HOAs influence sensitivity to contrast to varying degrees at different orientations [20].

These findings may have implications in pediatric patients at risk of amblyopia [13]. In addition, transient chalazion-induced astigmatism can disturb the visual acuity, mislead intraocular lens calculation before cataract surgery, and result in serious error during refractive surgery. Therefore, in these cases, chalazia should be treated in the early phase. Long-term chalazia may induce the remodeling of corneal stroma through the secretion of inflammatory mediators including matrix metalloproteinases. Chalazia excision can decrease corneal astigmatism and irregularity; this is more prominent in single, firm, and central upper eyelid lesions [14]. Treatment modality includes incision and curettage, intralesional triamcinolone injection, and intralesional botulinum injection.

Conclusions

Large-sized chalazia in the whole upper eyelid should be treated in the early phase because they induced the greatest change in corneal topography. Chalazion should be treated before corneal topography is performed preoperatively and before the diagnosis of corneal diseases.

Abbreviations

ANOVA: 

Analysis of variance

ARK: 

Autokeratorefractometer

CCT: 

Central corneal thickness

D: 

Diopter

HOA: 

High order aberration

K: 

Keratometry

RMS: 

Root mean square

Declarations

Acknowledgements

Not applicable.

Funding

This study was supported by the National Research Foundation (NRF) grant (NRF-2015R1D1A1A09058505) funded by the Korea government and by Hallym University Research Fund 2016 (HURF-2016-12).

Availability of data and material

If needed, data will be shared upon request.

Authors’ contributions

Literature screening and selection was performed by KWJ and YJS. JYH and YJS participated in the design of the study. KWJ and YJS drafted the manuscript. KWJ and YJS carried out the statistical analysis. YJS and JYH interpreted the data. JYH prepare and review of the manuscript. All authors have given final approval of the version to be published. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work.

Competing interests

The Authors declare that they had no competing interests.

Consent for publication

Not applicable.

Ethics approval and consent to participate

This study adhered to the tenets of the Declaration of Helsinki and was approved by the Institutional Review Board of Hallym University Medical Center. Informed consent was obtained from all subjects.

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Authors’ Affiliations

(1)
Department of Ophthalmology, Hallym University College of Medicine, Gangnam Sungshim Hospital
(2)
Department of Ophthalmology, Seoul National University College of Medicine
(3)
Department of Ophthalmology, Seoul National University Bundang Hospital

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© The Author(s). 2017

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