Abstract
Importance:
Despite the vast prevalence of chalazia, there remains limited data on demographic factors and medical comorbidities of chalazion diagnosis and no data on surgical risk factors of chalazion excision.
Objective:
To identify factors associated with chalazion diagnosis and surgical excision
Design:
A retrospective cohort study of patients with an incident chalazion diagnosis (n=134,959) were compared matched controls (678,160). Multivariate logistic regression was performed to identify variables associated with diagnosis and surgical excision.
Setting:
Data for this study were extracted from Optum’s de-identified Clinformatics® Data Mart Database which contains medical claims and demographic data from ambulatory care centers across the United States.
Participants:
Cohorts were created using all patients in the database from January 1, 2000, to June 30, 2019.
Main Outcomes and measures:
The demographic factors and medical comorbidities associated with chalazion diagnosis and surgical excision were studied.
Results:
Identified risk factors for diagnosis included female sex, non-white race, northeast location, conditions affecting periocular skin and tear film (blepharitis, meibomian gland dysfunction, rosacea, pterygium), non-ocular inflammatory conditions (gastritis, inflammatory bowel disease, sarcoidosis, seborrheic dermatitis, Grave’s disease) and smoking. Diabetes and systemic sclerosis diagnoses decreased odds of diagnosis (p<0.001). Male sex and rosacea diagnosis increased odds of surgery (p<0.001).
Conclusion and Relevance:
Female sex, non-white race, conditions affecting periocular skin and the tear film, non-ocular inflammatory conditions, and smoking were risk factors for chalazion diagnosis. Male sex and rosacea were risk factors for surgical intervention for chalazion. Our results prompt further study of these variables and their relationship to chalazion diagnosis to understand physiology and improve clinical outcomes. Furthermore, the results of this study suggest early recognition and treatment of concomitant rosacea may serve an important role in management of chalazion and in prevention of surgical intervention.
Introduction:
A chalazion is a chronic sterile lipogranulomatous lesion localized to the eyelid. It arises from obstruction of Meibomian glands or less commonly, glands of Zeis, and results from a foreign body reaction to the retained sebum produced by the gland.1 It is the most common eyelid lesion in the general population and can occur at any age with a rate of recurrence up to 35%.2,3 While chalazia are usually asymptomatic, potential complications include infection and visual blurriness or visual impairment due to corneal astigmatism and blockage of the visual axis with enlargement of lesions. Management typically is conservative with lid massage with warm compresses and lid hygiene. Topical antibiotics or antibiotic-steroid combinations may be used in conjunction, although their effectiveness is unclear.1,4 In refractory cases, surgical intervention involving incision and curettage or intralesional steroid injection may be pursued.
Despite the prevalence of chalazia, studies of demographic factors and medical comorbidities have been limited and none have focused on surgical risk factors.5,6 Some have found conflicting results on gender as a risk factor for incident chalazia,3,7,8 while other studies though limited by sample size and diversity of population studies have found conflicting results of the risk based on race and ethnicity.1,3,7 Lastly, some systemic disorders have also been implicated as risk factors for incurring chalazia including gastritis and irritable bowel syndrome.7
To date, predisposition to chalazia formation and those at risk for progressing to needing surgery in the U.S. remains unclear. Using a national cohort, we aim to evaluate demographic and medical risk factors of chalazion diagnosis and then separately, evaluate those at risk for surgical intervention of chalazion removal.
Methods:
Dataset
Data for this study were abstracted from Optum’s de-identified Clinformatics® Data Mart Database. This database contains all outpatient medical claims (office visits, procedures, and medications given) as well as demographic data for all patients enrolled in commercial and Medicare Advantage insurance plans. The subset of data available for this study included all patients in the database from January 1, 2000, to June 30, 2019. The institutional review board of the University of Pennsylvania deemed this study exempt from review due to the de-identified nature of the data.
Cohorts
Two distinct cohorts were created for analysis in this study. The first cohort was the incidence cohort and consisted of all patients who were newly diagnosed with a chalazion by an eyecare provider. Incident chalazion were defined as any patient who had at least two years in the dataset without a previous ICD code representing a chalazia or hordeolum diagnosis or a CPT code representing a chalazion removal. While this method cannot be certain that it will be the first incident a chalazion would have occurred in a patient, the two-year look back period without previous diagnosis dramatically reduces this possibility.9 The date of the chalazia diagnosis was considered the index date. The second surgical cohort was created from a subset of the patients found in the incidence cohort that had at least 90 days in the dataset after the date of the initial chalazion diagnosis. Specific to this cohort, however, all patients who had a CPT code for a chalazion removal procedure after the initial chalazion diagnosis were included. The index date for the second cohort was the date of the procedure (Please see Supplementary Table 1 for all ICD and CPT codes used within the study).
Incidence density sampling with replacement was performed to find matched controls for each cohort. To allow for maximal assessment of possible risk factors, controls for the incidence cohort was only matched on date of insurance plan entry and exit (±3 months) up to a 5:1 ratio. Controls were then assigned the index date of their matched chalazion patient. All exclusion criteria were then applied to the controls including the requirement to have seen any eye provider prior to the index date. Controls for the surgical cohort found using the same process as the controls for the incidence cohort but were pulled from the remaining patients in the incidence cohort who did not progress to having a surgical procedure for a chalazion removal.
Outcomes of Interest and Risk Factors assessed
Multivariable logistic regression models were created to determine odds of having an incident chalazion or a surgical removal of chalazion in separate models based on the risk factors of interest. All covariates were assessed as of the index date. Risk factors of interest included demographic variables (age, gender, race, education level, income, region of the country) and ocular clinical variables (blepharitis, pterygium, rosacea, meibomian gland dysfunction, and Grave’s ophthalmopathy) and systemic clinical variables (smoking, Sjogren’s syndrome, gastritis, irritable bowel syndrome, inflammatory bowel disease, peptic ulcer disease, seborrheic dermatitis, anxiety, diabetes mellitus, Lupus, rheumatoid arthritis, multiple sclerosis, Grave’s disease, and sarcoidosis). Due to the high number of risk factors assessed (25), a Bonferroni correction was used and only findings with a p-value of <0.002 were considered significant.
Results:
After inclusion and exclusion criteria were applied, 134,959 patients with an incident diagnosis of chalazion were found. These were then matched to 678,160 controls. Demographics associated with chalazion diagnosis included younger age (mean 52.71 +/− SD 20.69; median 55.00 QR1 40.00 QR3 69.00), female gender (57.7%), and non-white race (32.4%) (Table 1).
Table 1.
Demographic characteristics
| No Chalazion (N=678160) | Chalazion (N=134959) | Total (N=813119) | |
|---|---|---|---|
| Age | 56.77 (21.50) | 52.71 (20.69) | 56.10 (21.4%) |
| Gender | |||
| Female | 389863 (57.5%) | 79440 (58.9%) | 469303 (57.7%) |
| Male | 288297 (42.5%) | 55519 (41.1%) | 343816 (42.3%) |
| Race | |||
| White | 467078 (68.9%) | 90756 (67.2%) | 557834 (68.6%) |
| Black | 56406 (8.3%) | 11664 (8.6%) | 68070 (8.4%) |
| Asian | 24635 (3.6%) | 5545 (4.1%) | 30180 (3.7%) |
| Hispanic | 59426 (8.8%) | 12586 (9.3%) | 72012 (8.9%) |
| Unknown | 70615 (10.4%) | 14408 (10.7%) | 85023 (10.5%) |
| Education | |||
| Less than 12th Grade | 3302 (0.5%) | 441 (0.3%) | 3743 (0.5%) |
| High School Diploma | 147997 (21.8%) | 24863 (18.4%) | 172860 (21.3%) |
| Less than Bachelors | 341314 (50.3%) | 64302 (47.6%) | 405616 (49.9%) |
| Bachelor Degree + | 131611 (19.4%) | 34893 (25.9%) | 166504 (20.5%) |
| Unknown | 53936 (8.0%) | 10460 (7.8%) | 64396 (7.9%) |
| Income | |||
| <40K | 104835 (15.5%) | 15334 (11.4%) | 120169 (14.8%) |
| 40K to 49K | 165623 (24.4%) | 36682 (27.2%) | 202305 (24.9%) |
| 50K to 59K | 34472 (5.1%) | 5571 (4.1%) | 40043 (4.9%) |
| 60K to 74K | 39271 (5.8%) | 6348 (4.7%) | 45619 (5.6%) |
| 75K to 99K | 56117 (8.3%) | 9870 (7.3%) | 65987 (8.1%) |
| 100K+ | 84672 (12.5%) | 15754 (11.7%) | 100426 (12.4%) |
| Unknown | 193170 (28.5%) | 45400 (33.6%) | 238570 (29.3%) |
| Geographic division | |||
| Mountain | 57082 (8.4%) | 7993 (5.9%) | 65075 (8.0%) |
| Northeast | 78569 (11.6%) | 23731 (17.6%) | 102300 (12.6%) |
| Pacific | 90748 (13.4%) | 11684 (8.7%) | 102432 (12.6%) |
| South Atlantic | 164412 (24.2%) | 41311 (30.6%) | 205723 (25.3%) |
| Southern Midwest | 107371 (15.8%) | 20623 (15.3%) | 127994 (15.7%) |
| Unknown | 2563 (0.4%) | 267 (0.2%) | 2830 (0.3%) |
| Upper Midwest | 177415 (26.2%) | 29350 (21.7%) | 206765 (25.4%) |
In a multivariable analysis including the aforementioned variables, age (OR 0.99, p<0.001, i.e. every additional year of age reduced the odds by 0.01) and male gender (OR 0.97, p<0.001) were associated with decreased odds of diagnosis (Table 2). Hispanic (OR 1.20, 95% CI [1.18, 1.22]), Black (OR 1.15, 95% CI [1.12, 1.17]), Asian (OR 1.10, 95% CI [1.97, 1.13]), and unknown race (OR 1.11, 95% CI [1.07, 1.14]) were all associated with increased odds of diagnosis when compared to white race (p<0.001). Educational attainment of graduate degree (OR 1.57, 95% CI [1.43, 1.72]), bachelor’s degree (OR 1.26, 95% CI [1.15, 1.39]), and high school diploma (OR 1.14, 95% CI [1.04, 1.25]) were all associated with higher odds of diagnosis compared to those without a high school diploma (p<0.001). Incomes greater than $40k were also associated with higher odds of diagnosis and increased with income ($40k-49k OR 1.07, 95% CI [1.04, 1.11], $50k-59K OR 1.07, 95% CI [1.03, 1.10], $60k-74k OR 1.11, 95% CI [1.09, 1.14], $75k-99k OR 1.15, 95% CI [1.12, 1.17], $100k+ OR 1.21, 95% CI [1.19, 1.24], p<0.001). When compared to the Mountain location, Northeast (OR 2.01, 95% CI [1.96, 2.06]), South Atlantic (OR 1.76, 95% CI [1.71, 1.80]), Southern Midwest (OR 1.38, 95% CI [1.35, 1.42]), and Upper Midwest divisions (OR 1.15, 95% CI [1.13, 1.18]) were all associated with higher odds of diagnosis (p<0.001) while the Pacific division was associated with decreased odd of diagnosis (OR 0.93, 95% CI [0.90, 0.96], p<0.001). Medical comorbidities that increased odds of diagnosis included blepharitis (OR 2.38, 95% CI [2.33, 2.42], p<0.001), rosacea (OR 1.81, 95% CI [1.77, 1.85], p<0.001), and seborrheic dermatitis (OR 1.33, 95% CI [1.30, 1.36], p<0.001). Diabetes (OR 0.78, 95% CI [0.77, 0.79], p<0.001) and systemic sclerosis (OR 0.80, 95% CI [0.74, 0.87], p<0.001) were associated with decreased odds of diagnosis (see Table 2 for full multivariable results).
Table 2.
Multivariate logistic regression of patient characteristics and chalazion diagnosis
| Odds Ratio | 95% CI | p-value | |
|---|---|---|---|
| Age (1 year change) | 0.99 | (0.99 to 0.99) | <.001 |
| Gender (male ref) | 0.97 | (0.96 to 0.98) | <.001 |
| Race (white ref) | |||
| Black | 1.15 | (1.12 to 1.17) | <.001 |
| Asian | 1.10 | (1.07 to 1.13) | <.001 |
| Hispanic | 1.20 | (1.18 to 1.22) | <.001 |
| Unspecified | 1.11 | (1.07 to 1.14) | <.001 |
| Education | |||
| Less than Bachelors | 1.26 | (1.15 to 1.39) | <.001 |
| Bachelor+ | 1.57 | (1.43 to 1.72) | <.001 |
| Income ($) | |||
| Unknown | 1.41 | (1.38 to 1.44) | <.001 |
| 40K-49K | 1.07 | (1.04 to 1.11) | <.001 |
| 50K-59K | 1.07 | (1.03 to 1.10) | <.001 |
| 60K-74K | 1.11 | (1.09 to 1.14) | <.001 |
| 75K-99K | 1.15 | (1.12 to 1.17) | <.001 |
| 100K+ | 1.21 | (1.19 to 1.24) | <.001 |
| Geographic Distribution | |||
| Northeast | 1.59 | (1.55 to 1.62) | <.001 |
| Pacific | 1.19 | (1.16 to 1.21) | <.001 |
| South Atlantic | 1.43 | (1.40 to 1.46) | <.001 |
| Southern Midwest | 1.20 | (1.18 to 1.23) | <.001 |
| Ocular comorbidities | |||
| Blepharitis | 2.38 | (2.33 to 2.42) | <.001 |
| Meibomian gland dysfunction | 1.60 | (1.20 to 2.12) | 0.001 |
| Rosacea | 1.81 | (1.77 to 1.85) | <.001 |
| Pterygium | 1.14 | (1.08 to 1.20) | <.001 |
| Systemic comorbidities | |||
| Anxiety | 1.02 | (1.03 to 1.06) | <.001 |
| Diabetes | 0.78 | (0.77 to 0.79) | <.001 |
| Gastritis | 1.15 | (1.13 to 1.17) | <.001 |
| Graves | 1.18 | (1.13 to 1.22) | <.001 |
| IBD | 1.15 | (1.10 to 1.19) | <.001 |
| IBS | 1.23 | (1.21 to 1.26) | <.001 |
| Lupus | 1.03 | (0.97 to 1.10) | 0.286 |
| Peptic ulcer | 1.02 | (0.98 to 1.05) | 0.404 |
| Rheumatoid arthritis | 1.02 | (0.99 to 1.05) | 0.17 |
| Sarcoidosis | 1.19 | (1.09 to 1.30) | <.001 |
| Seborrheic dermatitis | 1.33 | (1.30 to 1.36) | <.001 |
| Sjogren’s | 0.99 | (0.95 to 1.04) | 0.746 |
| Systemic sclerosis | 0.80 | (0.74 to 0.87) | <.001 |
| Smoking | 1.02 | (1.00 to 1.03) | 0.05 |
Of the patients with a new chalazion diagnosis, we identified 16,168 who had at least 90 days in the dataset after diagnosis and underwent surgical removal of chalazion. These patients were then compared with the 107,983 remaining incident chalazion patients who did not have a procedure to remove the chalazion. In these patients, we further examined the above variables as well as use of antibiotics, steroids, or doxycycline.
Demographic factors associated with chalazion excision surgery on multivariate analysis included male sex (OR 1.47, 95% CI [1.42, 1.52], p<0.001), Black race (OR 1.40, 95% CI [1.32, 1.48]), p<0.001), Hispanic Race (OR 1.22, 95% CI [1.15, 1.29], p<0.001), and higher income (75k-99k OR 1.09, 95% CI [1.01, 1.17], p=0.022, 100k+ OR 1.09, 95% CI [1.02, 1.17], p=0.008) (Table 3). Higher education was associated with lower risk of excision at all levels after achieving high school diploma (high school OR 0.61, 95% CI [0.48, 0.79], bachelor’s OR 0.59, 95% CI [0.46, 0.75], beyond bachelor’s OR 0.53, 95% CI [0.42, 0.68], p<0.001). The Northeast location was associated with decreased odds of surgical excision compared to the Mountain region (OR 0.72, 95% CI [0.66, 0.78], p<0.001). Rosacea (OR 1.33, 95% CI [1.25, 1.42], p<0.001), antibiotic use (OR 1.33, 95% CI [1.19, 1.49], p<0.001), or doxycycline use (OR 1.26, 95% CI [1.13, 1.40], p<0.001) were associated with increased odds of surgical excision.
Table 3.
Multivariate logistic regression of patient characteristics and surgical intervention
| Odds Ratio | 95% CI | p-value | |
|---|---|---|---|
| Age (1 year change) | 0.99 | (0.99 to 0.99) | <.001 |
| Gender (male ref) | 1.47 | (1.42 to 1.52) | <.001 |
| Race (white ref) | |||
| Black | 1.40 | (1.32 to 1.48) | <.001 |
| Asian | 0.96 | (0.88 to 1.05) | 0.398 |
| Hispanic | 1.22 | (1.15 to 1.29) | <.001 |
| Unspecified | 1.02 | (0.93 to 1.11) | 0.736 |
| Education | |||
| Less than Bachelors | 0.59 | (0.46 to 0.75) | <.001 |
| Bachelor+ | 0.53 | (0.42 to 0.68) | <.001 |
| Income ($) | |||
| Unknown | 1.13 | (1.06 to 1.21) | <.001 |
| 40K-49K | 1.07 | (0.97 to 1.18) | 0.16 |
| 50K-59K | 1.07 | (0.97 to 1.17) | 0.173 |
| 60K-74K | 1.03 | (0.95 to 1.12) | 0.513 |
| 75K-99K | 1.09 | (1.01 to 1.17) | 0.022 |
| 100K+ | 1.09 | (1.02 to 1.17) | 0.008 |
| Geographic Distribution | |||
| Northeast | 0.72 | (0.66 to 0.78) | <.001 |
| Pacific | 0.98 | (0.90 to 1.07) | 0.72 |
| South Atlantic | 0.96 | (0.89 to 1.03) | 0.225 |
| Southern Midwest | 0.96 | (0.89 to 1.04) | 0.316 |
| Upper Midwest | 0.95 | (0.88 to 1.02) | 0.168 |
| Ocular comorbidities | |||
| Blepharitis | 1.02 | (0.96 to 1.08) | 0.618 |
| Rosacea | 1.33 | (1.25 to 1.42) | <.001 |
| Pterygium | 0.87 | (0.72 to 1.03) | 0.119 |
| Systemic comorbidities | |||
| Anxiety | 0.91 | (0.87 to 0.96) | <.001 |
| Diabetes | 0.81 | (0.77 to 0.85) | <.001 |
| Gastritis | 0.94 | (0.89 to 1.00) | 0.045 |
| Graves | 0.96 | (0.86 to 1.06) | 0.385 |
| IBD | 1.02 | (0.90 to 1.16) | 0.751 |
| IBS | 0.92 | (0.85 to 0.99) | 0.034 |
| Lupus | 1.06 | (0.87 to 1.29) | 0.554 |
| Peptic ulcer | 1.05 | (0.94 to 1.18) | 0.384 |
| Sarcoidosis | 0.71 | (0.51 to 0.96) | 0.033 |
| Seborrheic dermatitis | 0.86 | (0.80 to 0.93) | <.001 |
| Sjogrens | 0.72 | (0.61 to 0.85) | <.001 |
| Systemic sclerosis | 1.04 | (0.80 to 1.32) | 0.757 |
| Smoking | 0.88 | (0.84 to 0.93) | <.001 |
| Antibiotics | 1.33 | (1.19 to 1.49) | <.001 |
| Steroids | 1.03 | (0.92 to 1.14) | 0.643 |
| Doxycycline | 1.26 | (1.13 to 1.40) | <.001 |
Meibomian gland dysfunction excluded from analysis due to small sample size
Discussion/Conclusions:
Our study is the largest to study variables associated with chalazion diagnosis and excision in a cohort of U.S. patients. First, our study found that patients with increased age may have decreased likelihood of diagnosis – this may be explained by decreasing sebum excretion with age. One study showed sebum excretion declines by an average of 23% in males and 32% in females every 10 years post-adolescence10 whereas another showed sebum levels decrease after age 80 in men and after menopause until the 7th decade in women.11 Because sebaceous glands are under androgenic control, changes in sebum are thought to be due to concomitant decrease in production of androgens over time. Sebaceous glands also enlarge with age as a result of decreased cellular turnover, decreasing sebaceous obstruction.11
A higher prevalence rate of chalazion diagnosis was found in females, in patients with income greater than $40,000, and in adults with education beyond a high school level. This is consistent with prior reports of these factors being associated with higher eye care utilization rates.12,13 Interestingly, female sex and education greater than high school degree led to a decreased tendency to undergo surgical intervention for chalazion compared to their comparative counterparts despite higher rates of diagnosis, which may be a consequence of these groups presenting earlier for treatment, preventing the need for aggressive intervention such as surgery. Consistent with the theory that higher affluence leads to more diagnosis, we also found that patients with annual income higher than $40,000 were more likely than those below it to undergo surgical intervention, suggesting those with higher incomes are more likely to have surgical removal of an issue that those with less affluence may attempt to live with.
In concordance with previous reports,1,7 patients who identified as non-White races, including Black, Asian, and Hispanic, were more likely to be diagnosed with chalazion compared to Whites. While the reasons for this are unclear, studies have shown higher rates of sebaceous secretion occur with darker skin types.14,15 This is also supported by higher incidences of acne vulgaris, a disorder of sebum secretion, in these skin types.15
Patients from the Northeast, South Atlantic, Southern Midwest, and Pacific regions had more chalazion diagnoses compared to those from the Mountain region. The highest odds of diagnosis and lowest odds of surgical intervention for chalazion were seen in the Northeast division, which may be related to increased access to eye care and earlier treatment; a survey of 21,673 participants showed the Northeast had the highest frequency of ophthalmology visits.16 Another study of 2.2 million Medicare patients undergoing cataract surgery reported disparities in distance to the nearest cataract surgery provider based on geographic regions, wherein the Northeast had the shortest distance and subsequently, the highest cataract care utilization.17 Decreased geographic distance to an ophthalmologist may also contribute to increased odds of chalazion diagnosis in the Northeast division seen in our study.
Our data showed several ocular and medical comorbidities including rosacea, blepharitis, meibomian gland dysfunction (MGD), gastritis, anxiety, IBS, smoking, seborrheic keratosis as risk factors for diagnosis of chalazion, all of which is consistent with prior studies.3,7 Of particular interest, rosacea was the only condition that led to higher odds of both chalazion diagnosis and surgical intervention in our analysis. This may suggest that chalazia arising in setting of rosacea may be more refractory to conservative medical treatments.18 Ocular rosacea is frequently associated with blepharitis and meibomian gland dysfunction and is initially managed with lid hygiene with warm compresses, lid scrubs, digital lid massage, and dry eye therapies including topical cyclosporine, artificial tears and oral omega-3-fatty acids.19 Oral doxycycline, minocycline, and azithromycin have also been shown to have favorable impacts on matrix metalloproteinases and collagen abnormalities and have demonstrated improvements in tear break up time, ocular surface signs, and subjective symptoms in rosacea.19 Recent studies by Vazirna et al. noted that intense pulsed light therapy might also improve dry eye symptoms in patients with rosacea.20 Our findings that rosacea is associated with both diagnosis and surgical management of chalazia highlights the importance of early diagnosis and control of rosacea as a potential key component in management of chalazion.
Other novel risk factors for chalazion diagnosis identified in this study were Grave’s disease, IBD, and sarcoidosis. In a case series of 31 eyes with thyroid eye disease (TED) demonstrated about 25–50% loss of meibomian glands and greater loss of meibomian glands than inactive TED eyes.21 Knop et al. reported that ocular surface disease can lead to inflammation of the surrounding lid structures, leading to hyperkeratinization and compositional disturbance of meibum.22 Through this inflammatory process, meibomian gland dysfunction may take part in chalazion pathogenesis. Similarly, tear film abnormalities and dry eye symptoms are common in IBD and sarcoidosis,23,24 possibly related to the underlying systemic inflammatory processes driving local inflammatory reaction in the eyelids.
Given the sterile nature of chalazia, antibiotics are not typically indicated in their treatment, however, antibiotics are often prescribed in the setting of concomitant blepharitis, ocular rosacea, or suspected superimposed infection.4 A retrospective study showed 25% of 1,324 patients with newly diagnosed chalazia were prescribed topical and/or oral antibiotics, conceivably to address the aforementioned eyelid comorbidities or due to misdiagnosis as hordeolum, which is an infectious preseptal process. Furthermore, they demonstrated the addition of an antibiotic to conservative treatment for chalazion or hordeolum did not result in treatment success, in support of older studies.7,25 Correspondingly, this study revealed the use of antibiotics and tetracycline medications are associated with increased odds of surgical intervention, which may support that antibiotics do not necessarily help in treatment success of chalazia. Another possible explanation for our results is that patients who undergo surgical intervention likely have more severe cases and/or concomitant eyelid pathologies such as blepharitis that prompt the concurrent antibiotic use.
The results of this study need to be taken with the context of its design. Due to the de-identified nature of the administrative claims billing data we are unable to confirm specific diagnoses and procedures with individual chart level data. Furthermore, patients without insurance were unlikely to be included in this study due to reliance on the claims billing data, potentially limiting the generalizability of the data. Next, due to the nature of insurance, patients were able to come in and out of the insurance plan at any time. This means we are unable to identify “new” chalazion and may have misclassified some patients who had recurrent chalazion as new. While this may have occurred, the use of a 2-year look-back window suggests that those with recurrent chalazia had a 2-year period without seeking care for chalazia and when they did, it was likely due to a new recurrence and not a 2-year-old chalazion that went undiagnosed. Due to the vagaries of ICD9/ICD10 and CPT coding, we are also unable to fully account for patients with multiple concurrent chalazia which likely would impact the likelihood of having surgery.
Finally, while the variables of interest reflect a background literature review of known risk factors, they may be confounded by other variables that were not identified in our or other previous analyses.
Supplementary Material
Key Points:
Question:
What are the demographic and medical risk factors associated with chalazion diagnosis and excision?
Findings:
In this retrospective cohort study of 134,959 patients, female sex, non-white race, eyelid/tear film conditions, non-ocular inflammatory conditions, and smoking were associated with increased odds of chalazion diagnosis. Rosacea was the only risk factor associated with increased odds of both chalazion diagnosis and excision.
Meaning:
Certain demographics factors and medical comorbidities may predispose patients to developing chalazion. Early recognition and treatment of concomitant rosacea may serve an important role in management of chalazion and in minimizing risk of surgical intervention.
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