Idiopathic aseptic facial granuloma: A retrospective study of 43 cases.

BACKGROUND: Idiopathic aseptic facial granuloma (IAFG) is an underrecognized pediatric skin disease, currently considered within the spectrum of rosacea. It usually manifests as a solitary, reddish, asymptomatic nodule on the cheek that resolves spontaneously. METHODS: Retrospective and descriptive observational study of 43 pediatric patients with a clinical diagnosis of IAFG, followed between 2004 and 2022, at two general hospitals in Argentina. RESULTS: IAFG predominated in girls (65%) and the average age of onset was about 6 years. A single asymptomatic nodule was seen in 79% of patients. The most common localization was the cheek (58%) followed by lower eyelids (41%). Family history of rosacea was present in 16% of patients. A concomitant diagnosis of rosacea and periorificial dermatitis was made in 14% and 9% of our population, respectively. Past or present history of chalazia was detected in 42% of the children. IAFG diagnosis was mainly clinical (88% of cases). Oral antibiotics were the most common indicated treatment (84%). Complete healing was achieved by the majority, but 18% of those with eyelid compromise healed with scars. CONCLUSIONS: IAFG is a benign pediatric condition that physicians should recognize in order to manage correctly. We herein refer to a particular morphologic aspect of IAFG lesions affecting the lower eyelids, where nodules adopt a linear distribution and have a higher probability of involute leaving a scar. Also, we consider that the concomitant findings of rosacea, periorificial dermatitis and chalazia in our patients, reinforce the consideration of IAFG within the spectrum of rosacea.

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.

The association of demodex infestation with pediatric chalazia.

PURPOSE: This study aimed to investigate the association of Demodex infestation with pediatric chalazia. METHODS: In a prospective study, 446 children with chalazia and 50 children with non-inflammatory eye disease (controls) who underwent surgical treatment were enrolled from December 2018 to December 2019. Patient ages ranged from 7 months to 13 years old. All patients underwent eyelash sampling for light microscope examination, and statistical correlation analysis between Demodex infestation and chalazia, including the occurrence, recurrence, and course of disease, morphological characteristics, and meibomian gland dysfunction (MGD) in chalazia patients was performed. RESULTS: Demodex was found in 236 (52.91%) patients with chalazia and zero control patients. Demodicosis was significantly more prevalent in chalazia patients than the control group (P < 1 × 10- 14). Recurrent chalazia (P = 0.006) and skin surface involvement (P = 0.029) were highly correlated with Demodex infestation. Demodicosis was also associated with multiple chalazia (P = .023) and MGD(P = .024). However, Demodex infestation was comparable in the course of disease (P = 0.15), seasonal change (P = 0.68) and blepharitis subgroups (P = 0.15). Within the group of chalazia patients who underwent surgical removal of cysts, 4 (0.9%) patients with concurrent demodicosis experienced recurrence. CONCLUSIONS: Demodex infestation was more prevalent in pediatric chalazia patients than healthy children, and was associated with recurrent and multiple chalazia. Demodicosis should be considered as a risk factor of chalazia. In children with chalazia, Demodex examination and comprehensive treatment of Demodex mites should be applied to potentially prevent recurrence.

Clinical Report: Correlation of Serum Vitamins and Chalazion.

SIGNIFICANCE: We demonstrate the clinical correlation between the vitamin A level with chalazion in East Chinese children. Vitamin A deficiency is likely to be a potential cause of childhood chalazion. PURPOSE: Chalazion is the most common lid inflammatory lesion of the eyelid, which can be caused by retention of tarsal gland secretions. Studies have revealed that vitamin deficiency is an essential risk factor for children with chalazion. In this study, we measured the serum levels of vitamin A and 25-hydroxyvitamin D (25(OH)D), in patients with chalazion. METHODS: The study included 180 subjects (90 patients with chalazion and 90 control healthy subjects) with an average age of 4.13 ± 2.01 years, and 47.8% of whom were female. Serums came from blood samples collected and used to measure the levels of vitamin A and 25(OH)D. RESULTS: Both groups had statistically similar baseline characteristics, including age and body mass index. The average serum vitamin A levels in patients with chalazion (0.54 ± 0.15 µmol/L) were significantly lower than in their control counterparts (0.60 ± 0.15 µmol/L; P = .01). There was no significant difference in the serum 25(OH)D levels between the patients (70.15 ± 19.73 nmol/L) and control subjects (71.64 ± 24.46 nmol/L). The percentage of vitamin A deficiency in chalazion group (52.2%) was much higher than the control counterparts (28.6%; P = .001). The percentage of 25(OH)D deficiency showed no significant difference between patients with chalazion and control subjects (58.9 vs. 56.7%). CONCLUSIONS: Low serum vitamin A was significantly associated with chalazion in children. The serum 25(OH)D level exhibited no correlation with chalazion.

Focus on Ophthalmopathology - Orbital Infections from Hordeolum to Necrotizing Fasciitis. / Schwerpunkt Ophthalmopathologie Orbitainfektion: vom Hordeolum bis zur nekrotisierenden Fasziitis.

(Peri)orbital infections comprise a multitude of diagnoses, ranging from common hordeolum to rare but life-threatening necrotizing fasciitis. However, these disease entities are rarely diagnosed by an ophthalmic pathologist because (peri)orbital infections are usually diagnosed clinically, with the help of imaging and microbiological techniques when indicated. In this review article, the role of ophthalmopathology in the diagnosis of (peri)orbital infections is illustrated on the basis of several exemple diagnoses. An infectious hordeolum must be distinguished from a noninfectious chalazion. A nodular thickening of the eyelid, which is diagnosed and treated as a chalazion, can hide a malignant neoplasia. The correct diagnosis and treatment of canaliculitis is often delayed. In this context the most common causative organism, Actinomyces, can be depicted histologically, as can lacrimal stones/dacryoliths. Necrotizing fasciitis is a rapidly worsening infection of the fascia, which can lead to necrosis, sepsis, and death. During the Sars-CoV2 pandemic, an increased incidence of mucormycosis cases was observed, especially in India. This superinfection was facilitated by the widespread use of steroids and immunosuppression. Histologically, it is possible to visualize infiltration of vessel walls by the fungus. Ophthalmopathology contributes to the diagnosis and to understanding the pathophysiology of these diseases.

[Chronic mucocutaneous candidiasis with STAT1 gain-of-function mutation associated with herpes virus and mycobacterial infections]. / Candidose cutanéo-muqueuse chronique avec mutation gain-de-fonction du gène STAT1 associée à des infections herpétiques et à mycobactérie.

INTRODUCTION: Chronic mucocutaneous candidiasis (CMC) is characterized by susceptibility to chronic or recurrent infections with yeasts of the genus Candida affecting the skin, nails and mucous membranes. We describe a Moroccan patient presenting CMC with heterozygous STAT1 gain-of-function (GOF) mutation. PATIENTS AND METHODS: A 5-year-old boy with no consanguinity presented recurrent episodes of oral thrush, chronic nail candidiasis and herpetic gingivostomatitis from the age of 8 months. He also had mycobacterial adenitis secondary to BCG vaccination and atypical rosacea. Genetic analysis revealed GOF mutation of the STAT1 gene. DISCUSSION: CMC was diagnosed in our patient despite poor clinical features. Sequencing of the genome revealed STAT1GOF mutation. This mutation affects production of IL-17, an important cytokine in mucocutaneous defense against Candida. The association with mycobacterial adenitis is rare and continues to be poorly understood. The presence of atypical rosacea in this setting is suggestive of this entity. Antifungal therapy and prevention of complications are necessary to reduce the morbidity and mortality associated with this condition. CONCLUSION: CMC due to STAT1GOF mutation is characterized by a broad clinical spectrum and should be considered in all cases of chronic or recurrent fungal infection, whether or not associated with other infections.

The Relationship Between Eyebrow and Eyelid Position in Patients With Ptosis, Dermatochalasis and Controls.

PURPOSE: The purpose of this study is to explore mechanical and co-innervational factors involved in both voluntary and involuntary brow elevation among people affected by ptosis and dermatochalasis. METHODS: In this prospective cohort study of normal controls and eyelids with ptosis or dermatochalasis, marginal reflex distance (MRD1) and brow height were measured under the following conditions: neutral position, involuntary mechanical brow elevation, voluntary brow elevation, and maximal eyelid opening. The primary outcome measure was change in MRD1. Secondary outcome measures included brow height and coupling (mm brow height change per mm MRD1 change). Analysis of variance and t tests were performed for intra- and intercondition comparisons, respectively. RESULTS: Mechanical (involuntary) brow elevation significantly raised MRD1 in control eyelids and eyelids with dermatochalasis, but not in eyelids with ptosis. Voluntary brow elevation produced significantly greater brow height than maximal eyelid opening in controls and eyelids with dermatochalasis, but not in eyelids with ptosis. Maximal eyelid opening increased MRD1 greater than voluntary brow elevation significantly in control eyelids, but not in eyelids with dermatochalasis or ptosis. Coupling of the brow and eyelid margin during maximal eyelid opening was significantly greater in eyelids with ptosis relative to controls. CONCLUSIONS: In eyelids with ptosis, mechanical brow elevation does not change eyelid position; however, voluntary brow elevation raises eyelid position to a similar position as maximal eyelid opening. These results argue against the contention that the brow is elevated to mechanically lift the eyelid in ptosis and instead suggest that the brow elevation is driven by efforts to raise the eyelid, possibly via co-innervation.

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

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.

[Measurement of the index of infection by Demodex spp in patients with chronic blepharitis and in patients without other ocular diseases]. / Determinación de índice de infestación por Demodex spp, en pacientes con blefaritis crónica y en pacientes sin otra patología ocular.

BACKGROUND: Infestation by Demodex spp. in the palpebral edge follicles in humans is common. However, these mites are not routinely diagnosed in patients with or without ocular pathologies in Chile and their relevance is unclear. One of the eye diseases most related to infestation by Demodex spp. is blepharitis, a chronic inflammation of the eyelid margin with intermittent exacerbations, which is very common in ophthalmic practice. Its management is prolonged treatment, which is often ineffective, leading to relapses and frustration of patient and treating physician. Blepharitis can be typed by its etiology into various types, one of them is caused by Demodex folliculorum and another species, D. brevis. OBJECTIVE: The overall objective was to detect the presence and estimate the rate of infestation of Demodex spp. in healthy subjects and in patients with ocular pathology such as blepharitis, bacterial conjunctivitis, chalazion, and stye. PATIENTS AND METHODS: Samples of tabs from both lower eyelids of ophthalmologically healthy patients (23) and patients with ocular pathologies (9) were mounted in immersion oil as described in literature, then visualized with a 10x objective and confirmed with 40x objective. RESULTS: Detection rates of eggs, nymphs or adults of Demodex spp. in patients with and without ophthalmological problems were above and below 0.5 mites per tab, respectively. D.folliculorum was the species most frequently found. DISCUSSION: The results are consistent with the international literature on both the rate of infestation as the predominant species. CONCLUSION: This paper is the first study in Chile on this subject and represents a significant contribution to ophthalmic clinical diagnosis and treatment of patients with this disease.

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.

Upper Eyelid Nodule - An Unusual Presentation of Ocular Demodicosis.

INTRODUCTION: Demodex mite is an external parasite which is implicated in various ocular conditions like anterior blepharitis, posterior blepharitis, meibomian gland dysfunction, chalazia and others. Although demodex has been shown to be a causative agent of chalazia, occurrence of a solitary inflammatory nodule due to demodex infestation has not been reported in literature. CASE: Our case describes the occurrence of an upper eyelid mass in a 62-year-old female which was found to have an associated demodex infestation. CONCLUSION: This is the first report of demodex infestation presenting as a nodular eyelid mass. This parasite needs to be considered in the differential diagnosis of eyelid masses as this condition requires specific management.

Recurrent giant chalazia in hyperimmunoglobulin E (Job's) syndrome.

Hyperimmunoglobulinemia E (Job's) syndrome is a rare autosomal dominant disorder appearing early in life with recurrent skin and pulmonary infections, characterized by markedly increased serum immunoglobulin E (IgE) levels. We describe a 50-year-old man with a 4-year history of recurrent, multiple giant chalazia in all eyelids. Medications and surgical intervention had produced only transient improvement. The patient had also had pulmonary and scalp infection. Laboratory tests disclosed elevated serum IgE (>1,000 IU/ml) and eosinophilia. As a result, based on the patient's history and clinical and laboratory findings, a diagnosis of Job's syndrome was made. Even though rarely, recurrent multiple giant chalazia may occur as an ophthalmic feature of Job's syndrome. Hyperimmunoglobulinemia E syndrome should be suspected in any case of recurrent giant chalazia, regardless of the patient's age. Measurement of serum IgE and eosinophils, along with internal evaluation, is essential to establish a proper diagnosis.

Etiopathogenetic patterns of blepharoptosis in Western Nepal : an Overview.

BACKGROUND: The clinical picture of blepharoptosis varies from a cosmetic problem to severe visual dysfunction depending on the pathogenesis and the degree of ptosis. OBJECTIVE: To study the type, pattern and causes of ptosis in patients seeking oculopastic care in western Terai of Nepal Patients and methods: A retrospective descriptive hospital based was carried out over a period of 2 years in oculoplastic clinic in Lumbini Eye Institute, Bhairahawa. Demographic variables including the age of the patient, gender, laterality of the eye(s), visual acuity, presence of refractive error and or amblyopia, type of ptosis and previous ptosis surgery were recorded. RESULTS: There were altogether 326 patients of ptosis during the 2 year-period. Congenital ptosis presented early the mean age being 23(SD ±9.91) years. Acquired ptosis presented late with the mean age of 35(SD± 14.98) years. Congenital ptosis was more common (52%) compared to acquired ptosis (48%). 4.7% of congenital ptosis had amblyopia. Among all ptosis patients, myogenic cause of ptosis was the commonest followed by mechanical, aponeurotic, traumatic and neurogenic. Simple congenital ptosis was the commonest, and among acquired ptosis, mechanical ptosis was the commonest. Most of the ptosis was unilateral (87.7%) regardless of its onset either congenital or acquired. Regarding the severity of ptosis, mild ptosis was the commonest. CONCLUSION: Ptosis was the 3rd most common lid condition in oculoplastic clinic presentation after entropion and chalazion. Simple congenital ptosis was the commonest form of ptosis.

[Unusual course of a chalazion]. / Ungewöhnlicher Verlauf eines "Chalazions".

BACKGROUND: A chalazion is a benign, inflammatory tumor of the eyelid caused by an obstruction of the excretory duct of a meibomian gland. Usually a chalazion shows a slow painless and non-inflammatory progression. Interestingly, sinus infections can initially simulate chalazia by causing an orbital involvement with eyelid swelling. CASE REPORT: We report the case of a 15-year-old boy with frontal and ethmoidal sinusitis with inflammatory orbital infiltration and subacute eyelid swelling. The cerebral imaging showed an encapsulated brain abscess so that an urgent surgical removal of the abscess cavity was indicated. After several neurosurgical procedures a complete remission of the abscess could be achieved. In spite of the large abscess in the frontal lobe the boy never showed any neurological or psychiatric symptoms. CONCLUSION: In atypical courses of a chalazion the clinical picture requires further diagnosis including evaluation and imaging in otorhinolaryngology and neurology.

Chalazion as a cause of decreased vision after LASIK.

PURPOSE: To describe a post-LASIK patient with decreased vision and a chalazion of the upper eyelid. METHODS: A 46-year-old man was referred with decreased vision of 1 month's duration. He underwent bilateral uncomplicated LASIK for myopic astigmatism 1.5 years and bilateral enhancements 1 year previously. He had 20/20 uncorrected vision in both eyes after those procedures. He developed a chalazion of his right central upper eyelid 1 month prior with simultaneous blurring of vision. On our examination, his uncorrected visual acuity was 20/60 in the right eye. Complete eye examination including refraction, computerized corneal topography, and pachymetry were done. RESULTS: With a manifest refraction of +1.25 +0.50x80, the visual acuity in the right eye improved to 20/20. Computerized corneal topography revealed circular central corneal flattening in both eyes, much greater in the right eye than the left eye. The location of the chalazion with the right eye closed corresponded to the area of central corneal flattening. The central power from the corneal topography was 39.4 D OD and 40.8 D OS. He was diagnosed as having acquired hyperopia associated with chalazion-induced central corneal flattening of the right eye. Chalazion-induced hyperopic change on topography disappeared, and his uncorrected vision improved to 20/20 in the left eye as the chalazion resolved completely. CONCLUSION: In post-LASIK patients with decreased vision and topography changes late after surgery, periocular masses should be considered in the differential diagnosis. Decreased corneal thickness and rigidity after LASIK might be a predisposing factor to external compression-induced curvature changes.

Giant chalazia in the hyperimmunoglobulinemia E (hyper-IgE) syndrome.

PURPOSE: To report the occurrence of recurrent multiple giant chalazia in the hyperimmunoglobulin E syndrome (hyper-IgE syndrome or Job syndrome). METHODS: Two patients with hyperimmunoglobulinemia E (>500 IU/ml) had ophthalmologic examination and surgical treatment for chalazia of the eyelids. RESULTS: The hyper-IgE syndrome is a rare immunodeficiency and multisystem disorder characterized by recurrent skin and pulmonary abscesses, connective tissue abnormalities, and elevated levels of serum IgE. In two patients with the hyper-IgE syndrome, multiple giant chalazia were seen in upper and lower eyelids. Despite surgical incision new giant chalazia arose. CONCLUSIONS: Recurrent multiple giant chalazia may occur as an ophthalmic feature of the hyper-IgE syndrome.