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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 3 0 | C A T A L Y S T 2022-2023
expensive and invasive than most patients are willing to accept. Infrequent biopsies reduce the accuracy of chalazia detection. Many patients either allow the chalazia to recede over time or do not seek medical treatment. Even when surgical curettage is performed on larger chalazia, physicians rarely retain the excised chalazion for biopsy and later study [5]. As a result, there is a distinct lack of data on the different causes of chalazia. It is simpler to prescribe antibiotics or excise a chalazion, thus few physicians will perform PCR, immunoassays, and micrography to learn more about the causes behind chalazion formation. All of these reviewed papers posit a question: on a molecular level, how do these pathogens and drugs lead to chalazion formation? The reviewed papers noted symptoms, causes, and identified pathogens. Yet, each paper could only theorize a molecular mechanism. 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. In the meantime, ophthalmologists would greatly benefit from performing biopsies more frequently. Research would benefit from chalazia biopsies when the patient has any sort of medical history of eye damage, or if the chalazia is of abnormal size or location. Though ophthalmologists do not yet comprehensively understand chalazion etiology, early detection will significantly mitigate harmful complications. WORKS CITED [1] Patel, S. et al. Prevalence and Risk Factors for Chalazion in an Older Veteran Population. British Journal of Ophthalmology 2022, 106 (9), 1200–1205. [8] Truong, T. et al. Detecting Proper Mask Usage with Soft Attention. In 2020 IEEE Symposium Series on Computational Intelligence (SSCI); 2020; pp 1745–1750. [9] Gupta, S. et al. Docetaxel-Induced Meibomian Duct Inflammation and Blockage Leading to Chalazion Formation. Prostate Cancer Prostatic Dis 2007, 10 (4), 396–397. [10] Pavelka, M. et al. On the Hydrolysis Mechanism of the Second-Generation Anticancer Drug Carboplatin. Chemistry – A European Journal 2007, 13 (36), 10108–10116. [11] Pourahmad, J. et al. Biological Reactive Intermediates That Mediate Dacarbazine Cytotoxicity. Cancer Chemother Pharmacol 2009, 65 (1), 89–96. DESIGN BY Jenny She EDITED BY Ben Walls [2] Mansour, A. M et al. Virus-Induced Chalazion. Eye 2006, 20 (2), 242–246. [3] Silkiss, R. Z. et al. Increased Incidence of Chalazion Associated with Face Mask Wear during the COVID-19 Pandemic. American Journal of Ophthalmology Case Reports 2021, 22, 101032. [4] Nemoto, Y. et al. Differentiation between Chalazion and Sebaceous Carcinoma by Noninvasive Meibography. Clin Ophthalmol 20<strong>14</strong>, 8, 1869–1875. [5] Park, J.; Kyung, S. Unilateral Primary Tuberculosis Presenting as an Extratarsal Chalazion. Canadian Journal of Ophthalmology 2017, 52 (1), e1–e3. [6] Hopewell, P. C.; Jasmer, R. M. Overview of Clinical Tuberculosis. In Tuberculosis and the Tubercle Bacillus; John Wiley & Sons, Ltd, 2004; pp 13–31. [7] Yang, J. W.; Kim, Y. D. A Case of Primary Lid Tuberculosis after Upper Lid Blepharoplasty. Korean Journal of Ophthalmology 2004, 18 (2), 190–195. 2022-2023 C A T A L Y S T | 3 1
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