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    Chalazion, Hordeolum, and Stye – Diagnosis and Treatment

    Ears, Eyes, Nose, and Throat, Inflammatory

    Last Reviewed on May 03, 2021
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    By Julian Marsden,Melissa Lee

    Context

    Chalazia and hordeola (styes) are sudden-onset localized swellings of the eyelid.

    Hordeolum (Stye) = acute bacterial infection or abscess of the eyelid.

      • External hordeola arise from glands in the eyelash follicle or lid margin (gland of Zeis and gland of Moll).
      • Internal hordeola are caused by inflammation of the meibomian gland, resulting in swelling under the conjunctival side of the eyelid.
      • Staphylococcus aureus is the most common bacteria causing a hordeolum.

    Chalazion = chronic form of a hordeolum caused by non-infectious meibomian gland occlusion.

      • Extravasation of irritating lipid material in the eyelid soft tissues with focal secondary granulomatous inflammation.
      • Chalazion becomes a small non-tender nodule in the eyelid center, and a hordeolum remains painful and localizes to an eyelid margin.

    Diagnostic Process

    Presentation

    • Hordeola (stye):

      • Classic: localized painful and erythematous swelling eyelid lesion (Figure 1).
      • Visual changes: decreased visual acuity.
      • Risk factors:
        • Rosacea.
        • Seborrheic dermatitis.
        • Poor lid hygiene.
        • Blepharitis.
        • Eye makeup.
    • Chalazia:

      • Classic: slowly enlarging, non-tender eyelid nodule <1cm in size (Figure 2).
          • Chalazia are typically painless, less erythematous and longer-lasting than hordeola.
      • Visual changes: decreased visual acuity.
      • Eyelid should be everted as part of the examination to evaluate for internal chalazion.
      • Risk factors:
          • Rosacea.
          • Seborrheic dermatitis.
          • Blepharitis.
          • Poor lid hygiene.
          • Eye makeup.
          • Chronic blepharitis.

    Figure 1. A hordeolum (stye) cause by an acute plugging of a meibomian gland.

    Figure 2. A chalazion (nodular lesion) present on the upper eyelid.

    Differential considerations.

    • Chalazion can mimic an internal hordeolum.
      • A chalazion will develop into a painless granulomatous nodule.
    • Both hordeola and chalazia have similar differential diagnoses:
      • Epidermoid cyst.
      • Blepharitis / meibomitis.
      • Acute dacryocystitis.
      • Herpes simplex virus blepharitis.
      • Apocrine hydrocystoma.
      • Orbital cellulitis.
      • Malignancy: basal cell, sebaceous cell, or meibomian gland carcinomas.
      • Tuberculosis.
    • Red flags pointing away from hordeola and chalazia:
      • Persistent or recurrent lesions (especially if unilateral).
      • Acute visual changes or eye pain.
      • Fever.
      • Extraocular movement limitations.
      • Diffuse eyelid or facial swelling.

    Recommended Treatment

    Drainage

    • Spontaneous drainage of hordeola or chalazia without any treatment can occur.

    Initial Treatment

    Persistent or recurrent lesions

    Hordeola · Warm compress for 5 to 10 minutes three to five times per day to encourage drainage.

    · Eyelid massage to encourage purulent drainage.

    · Eyelid scrub with saline or baby shampoo to promote drainage.

    · Discontinuation of eye makeup to support healing.

    · If lesion does not reduce in size within one to two weeks, a referral to an ophthalmologist should be made for consideration of incision and drainage or curettage.

    · May require antibiotic therapy to shorten duration and severity such as erythromycin ophthalmic ointment or topical steroids.

    · Recurrent hordeola should be biopsied to rule out sebaceous cell carcinoma.

    Chalazia  

    · Warm compress for 5 to 10 minutes three to five times per day to encourage drainage.

    · Eyelid massage to encourage purulent drainage.

    · Eyelid scrub with saline or baby shampoo to promote drainage.

    · Discontinuation of eye makeup to support healing.

    · If chalazia persists, refer to an ophthalmologist for consideration of incision and drainage or glucocorticoid injection.

    · If infectious etiology, antibiotics may be prescribed.

    · Recurrent chalazia should be biopsied to rule out sebaceous cell carcinoma.

    Criteria For Hospital Admission

    Most hordeola and chalazia are managed as outpatients.

    • Patients with severe complications such as orbital cellulitis require empiric antibiotic treatment based on common infecting organisms (Staphylococcus aureusStreptococcus pneumoniae, other streptococci and anaerobes).*Referral to an ophthalmologist should be made.

    Criteria For Close Observation And/or Consult

    Referral to an ophthalmologist is made for recurrent and persistent lesions or severe complications such as orbital cellulitis.

    Criteria For Safe Discharge Home

    Most hordeola and chalazia are managed as outpatient.

    Related Information

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