Chalazion Risk Rises With Systemic Disease, Environmental Factors

Patients with concomitant ocular and periocular disease, gastritis or irritable bowel syndrome (IBS), and those living in cities near water, have a higher risk of presenting with chalazion than others, according to a study published in British Journal of Ophthalmology. Researchers suspect environmental conditions in cities near water, such as elevated humidity and airborne pollutants, may increase the risk associated with chalazion prevalence.  

Researchers conducted a retrospective case-controlled study to examine 3,453,994 patients seen within US Veterans Affair (VA) eye clinics between October 2010, and October 2015 to evaluate the geographic distribution of chalazion cases and their risk factors. Patients were split into 2 groups based on the presence or absence of chalazion. Demographics, clinical characteristics, comorbid conditions, allergic conditions, and medication was collected. Cases were mapped based on the treatment facilities’ location to examine the spread across the United States. 

A total of 208,720 patients (mean age, 69.32±13.9; 93.50% men) presented with chalazion. The study shows chalazion presence significantly associated with a variety of systemic factors including smoking (OR=1.12, P <.0005), obesity (OR=1.32, P <.0005), hypertension (OR=1.38, P <.0005) depression (OR=1.35, P <.0005), and anxiety (OR=1.31, P <.0005).

However, ocular surface diseases, dermatological, and gastrointestinal diseases, as well as certain medication use, and even geographical factors all have significant relationships to chalazion development, as well. 

Ocular surface and periocular diseases have the highest association with chalazion presence, according to the report. The researchers detail significant associations between chalazion and blepharitis (OR=4.84, P <.0005), conjunctivitis (OR=2.78, P <.0005), and dry eye disease (OR=3.0, P <.0005). 

Dermatological issues, especially those affecting periocular skin (including eyelid dermatitis [OR=2.95, P <.0005], rosacea [OR=2.50, P <.0005], allergic rhinitis [OR=1.49, P <.0005], and a history of allergies [OR=1.56, P <.0005]), also raise the likelihood of chalazion development. 

Gastrointestinal disease has long been associated with chalazion, with this study showing particular links with gastritis (OR=1.54, P <.0005), and IBS (OR=1.45, P <.0005). 

While several medications reviewed can increase the risk of chalazion development, 3 classes of medications — statins (OR: 0.98; P =.02), topical carbonic anhydrase inhibitors (OR: 0.93; P <.0005), and topical beta-blockers (OR: 0.47; P <.0005) — actually reduce it, researchers report. 

Finally, chalazion prevalence is higher in cities near large bodies of water. Investigators report that they observed the highest rates of chalazion in Detroit (36.95%) and Fresno, California, (21.84%). “Densely populated coastal cities have elevated humidity and airborne pollutants levels compared with noncoastal cities. While no studies have examined the effects of these environmental variables on chalazion risk, these factors have been implicated in risk for blepharitis, conjunctivitis, and [dry eye disease],” the researchers report. “Interestingly, the frequency of internet searches for chalazion (stye) increases during hotter months, also linking environmental exposure to chalazion.”

The researchers suggest clinicians consider these ocular and systemic conditions  when examining patients with chalazion. 

The study limitations included relying on ICD-9 codes for classification since researchers could not verify information against clinical notes and using the veteran population since it represented a small sample of the general US population.