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.

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.

Drainage

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

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 aureus, Streptococcus pneumoniae, other streptococci and anaerobes).*Referral to an ophthalmologist should be made.

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

Most hordeola and chalazia are managed as outpatient.

1. Hordeolum.
   Bragg, K.J., Le, P. H., Le, J.K. (2020).
   StatsPearls [Internet].

   
   

2. Eyelid lesions
   Ghosh, C., Ghosh, T.  –  [cited 2021, Apr 3]
   [UpToDate – Internet].

   
   

3.  Chalazion. 
   Jordan, G.A., Beier, K. (2020).
   [StatsPearls Internet].

   
   

4. Stye (Hordeolum)–Review
   Sreeremya, S. (2018). 4(1), 8-9.
   [International Journal of Molecular Biotechnology]