Prevalence of Blepharokeratoconjunctivitis and Refractive Amblyopia Risk Factors in Children With Chalazia: Safety Considerations in Telehealth Management.

PURPOSE: To examine the prevalence of corneal changes and refractive amblyopia risk factors (ARFs) associated with blepharokeratoconjunctivitis (BKC) to evaluate the safety of remote pediatric chalazion management.

METHODS

The authors retrospectively reviewed 381 in-person patients with chalazia 0 to younger than 18 years. The prevalence of corneal changes associated with BKC in all patients with chalazion 0 to younger than 18 years was compared with the population prevalence. Patient-reported symptoms were compared in patients with chalazion with and without corneal findings associated with BKC. The 2021 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) ARF and visually significant refractive error failure level definitions were used to compare population prevalence of refractive ARFs to prevalence in patients with chalazia younger than 9 years.

RESULTS

Ten of 381 patients with a chalazion (2.62%) had simultaneous active corneal changes associated with BKC, with a relative risk compared to the population of 444.9739 (P < .0001); 90% reported eye pain, eye redness, photophobia, or blurred vision. The prevalence of patients with a chalazion who concurrently met the 2021 AAPOS ARF and visually significant refractive error failure level definitions was 9.89% in 71 patients younger than 48 months and 21.79% in 78 patients 48 months to younger than 9 years. The relative risk of refractive ARFs was 1.7871 (P = .1397) in patients with chalazion younger than 48 months and 1.8014 (P = .0261) in those 48 months to younger than 9 years compared to the general population.

CONCLUSIONS

The elevated risk of corneal changes associated with BKC in patients with chalazia 0 to younger than 18 years and refractive ARFs in patients with chalazia 48 months to younger than 9 years should prompt screening for these conditions in association with teleophthalmology encounters. [J Pediatr Ophthalmol Strabismus. 2025;62(4):278-285.].