[Rice Catalyst Issue 14]

Figure 2: Chalazion Incidence in UCLA
and New Cases of COVID-19 in LA County:
The monthly prevalence of chalazia cases at
University of California Los Angeles (UCLA)
is compared with new COVID-19 cases in
Los Angeles (LA) county, California.
2018-2020 Chalazia data is expressed as a
proportion of all ophthalmology cases on
the left column, while new COVID-19 cases
are displayed through 2020 on the right
column. No COVID-19 data is available
before 2020. All data was sourced from
clinic and UCLA medical records [3].
Oral pathogens are a complex cause of
chalazia. The global pandemic necessitates
frequent mask-wearing to mitigate
community spread of
the virus, yet most
people do not
properly wear a mask
or maintain adequate
oral hygiene [8]. As a
result, increased
mask-wearing
facilitates more
frequent oral-eye
interactions, which
has potentially driven
an increase in
chalazia prevalence.
Though COVID-19 can
be detected relatively
easily through PCR or
antigen-based testing,
oral pathogens can be
harder to detect in
the eye without
dedicated biopsy.
Similar to TB, oral
pathogens are rarely
tested for and may be
an underrepresented
cause of chalazia [3].
Viruses, including respiratory infections,
could also play a direct role in chalazion
formation [2]. A seven-year study of first
time chalazia patients found that nearly half
of studied patients (n=27) reported some
sort of respiratory infection occurring
before the emergence of a chalazion [2]. To
rule out confounding variables, the study
did not include any patients with a medical
history of eye disease or surgeries. Viral
presence was confirmed by patient
biopsies; electron micrography revealed
numerous viral particles within somatic
cells. Nearly all viral infections were
associated with both chalazia and conjunctivitis
(inflammation of the conjunctiva) of
one or both eyes, strengthening the
connection between viral respiratory
infections and eye disease. Interestingly,
the study suggests that chalazia may be
partially contagious [2]. Patient One of the
study initially developed a chalazion and
conjunctivitis. Within a week, most of her
immediate family, who had no prior
medical history of eye complication, had
also developed the same diseases. The
likely mechanism of spread was viral
propagation through touch and/or
respiratory droplets. This case study
weakened the historical belief that chalazia
TB, respiratory viruses,
and oral
pathogens can
all find ways to
attack the eye’s
meibomian
glands.
are an individual, non-contagious disease
[2]. Viruses can spread extremely easily
throughout populations and do not readily
respond to antibiotics and other common
medications, hindering chalazion
treatment.
AN ABIOTIC ORIGIN OF
CHALAZIA
Not all cases of chalazia stem from
pathogens and other biotic sources. In rare
cases, chemotherapy can lead to chalazion
development [9].
Certain aggressive
cancers of the breast
and prostate are
treated with
Docetaxel, a
chemotherapeutic
drug that severely
hinders mitosis.
Though it improves
patient prognosis
and promotes tumor
reduction, the drug
negatively impacts
fluid retention,
neuromuscular
health, and nail and
hair health [9]. In the
Gupta et al. case
study, an elderly
patient with
metastatic prostate
cancer and no
previous medical
history of eye issues
developed a large
chalazion as a side effect of taking
Docetaxel (Figure 3) [9]. Unlike conventional
chalazia, this mass caused significant
irritation, lacrimation (frequent tear
secretion), and hemorrhage. Even after
surgical curettage and biopsy, the patient
continued to exhibit irritation and lacrimation.
The authors of the study theorized
that Docetaxel secretion in the tears and
meibum led to inflammation of the
meibomian gland area and the subsequent
chalazion [9]. Disrupted cell division
hampered effective tear production,
causing irritation and lacrimation.
Figure 3: Chalazion of Patient with
Prostate Cancer. A 71-year old patient with
metastatic prostate cancer developed a
chalazion on the lower right eyelid following
treatment with Docetaxel. Chalazion was
accompanied by lacrimation and conjunctivitis
[9].
Cancer is one of the leading causes of
death in developed countries [9].
Treatments almost always include radiation
therapy and chemotherapy. The numerous
associated side effects have seen little
research into how they may affect eye
health. Chemotherapy drugs, such as
Docetaxel, can wreak havoc on the delicate
eye environment. Other common cancer
drugs, such as carboplatin and decarbazine,
also attack the cell cycle and may have
similar side effects [10] [11]. Though
chalazia are rarely life-threatening, early
detection and proper treatment can greatly
increase the quality of life of chemotherapy
patients.
CONCLUSIONS
Chalazia are unique in their variety of
origins. TB, respiratory viruses, and oral
pathogens can all find ways to attack the
eye’s meibomian glands. Administered
medication can even lead to chalazia
formation. The eye’s membranous nature,
Future research
should explore
how eye tissues
respond to chalazion
causes at a
molecular level.
Only then can
more effective
drugs be developed
to treat
persistent chalazia.
constant motion, and multitude of glands
and ducts all leave it vulnerable to these
vectors. All discussed etiologies can appear
outwardly similar, requiring more tests
and/or biopsies (Figure 1), which are more
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