11/18/2018 Chalazion and Hordeolum (Stye) - Eye Disorders - MSD Manual Professional Edition

MSD MANUAL

Professional Version
Professional / Eye Disorders / Eyelid and Lacrimal Disorders

Chalazion and Hordeolum

(Stye)
By James Garrity, MD, Whitney and Betty MacMillan Professor of
Ophthalmology, Mayo Clinic College of Medicine

Chalazia and hordeola (styes) are sudden-onset localized swellings of the eyelid. A chalazion is
caused by noninfectious meibomian gland occlusion, whereas a hordeolum usually is caused by
infection. Both conditions initially cause eyelid hyperemia and edema, swelling, and pain. With
time, a chalazion becomes a small nontender nodule in the eyelid center, whereas a hordeolum
remains painful and localizes to an eyelid margin. Diagnosis is clinical. Treatment is primarily with
hot compresses. Both conditions improve spontaneously, but incision or, for chalazia,
intralesional corticosteroids may be used to hasten resolution.

Chalazion

A chalazion is noninfectious obstruction of a meibomian gland causing extravasation of irritating

lipid material in the eyelid soft tissues with focal secondary granulomatous inflammation.
Disorders that cause abnormally thick meibomian gland secretions (eg, meibomian gland
dysfunction, acne rosacea) increase the risk of meibomian gland obstruction.

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Chalazion

SCIENCE PHOTO LIBRARY

Hordeolum

A hordeolum (stye) is an acute, localized swelling of the eyelid that may be external or internal
and usually is a pyogenic (typically staphylococcal) infection or abscess. Most hordeola are
external and result from obstruction and infection of an eyelash follicle and adjacent glands of
Zeis or Moll glands. Follicle obstruction may be associated with blepharitis. An internal
hordeolum, which is very rare, results from infection of a meibomian gland. Sometimes cellulitis
accompanies hordeola.

Hordeolum (External)

DR. CHRIS HALE/SCIENCE PHOTO LIBRARY

Symptoms and Signs

Chalazia and hordeola each cause eyelid redness, swelling, and pain.

Chalazion

Initially the eyelid is diffusely swollen. Occasionally the eyelid can be massively swollen, shutting
the eye completely. After 1 or 2 days, a chalazion localizes to the body of the eyelid. Typically, a
small nontender nodule or lump develops. A chalazion usually drains through the inner surface
of the eyelid or is absorbed spontaneously over 2 to 8 wk; rarely, it persists longer. Depending on
its size and location, a chalazion may indent the cornea, resulting in slightly blurred vision.

Hordeolum

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After 1 to 2 days, an external hordeolum localizes to the eyelid margin. There may be tearing,
photophobia, and a foreign body sensation. Typically, a small yellowish pustule develops at the
base of an eyelash, surrounded by hyperemia, induration, and diffuse edema. Within 2 to 4 days,
the lesion ruptures and discharges material (often pus), thereby relieving pain and resolving the
lesion.

Symptoms of an internal hordeolum are the same as those of a chalazion, with pain, redness,
and edema localized to the posterior tarsal conjunctival surface. Inflammation may be severe,
sometimes with fever or chills. Inspection of the tarsal conjunctivae shows a small elevation or
yellow area at the site of the affected gland. Later, an abscess forms. Spontaneous rupture is
rare; however, when it does occur, it usually occurs on the conjunctival side of the eyelid and
sometimes erupts through the skin side. Recurrence is common.

Diagnosis
Clinical assessment

Diagnosis of chalazion and both kinds of hordeola is clinical; however, during the first 2 days,
they may be clinically indistinguishable. Because internal hordeola are so rare, they are not
usually suspected unless inflammation is severe or fever or chills are present. If the chalazion or
hordeolum lies near the inner canthus of the lower eyelid, it must be differentiated from
dacryocystitis and canaliculitis, which can usually be excluded by noting the location of maximum
induration and tenderness (eg, eyelid for a chalazion, under the medial canthus near the side of
the nose for dacryocystitis, and over the punctum for canaliculitis). Chronic chalazia that do not
respond to treatment require biopsy to exclude tumor of the eyelid.

Treatment
Hot compresses

Sometimes drainage or drug therapy, such as corticosteroid injection (for chalazia) or oral
antibiotics (for hordeola)

Hot compresses for 5 to 10 min 2 or 3 times a day can be used to hasten resolution of chalazia
and external hordeola.

Chalazion

Incision and curettage or intrachalazion corticosteroid therapy (0.05 to 0.2 mL triamcinolone 25

mg/mL) may be indicated if chalazia are large, unsightly, and persist for more than several weeks
despite conservative therapy.

Hordeolum

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An external hordeolum that does not respond to hot compresses can be incised with a sharp,
fine-tipped blade. Systemic antibiotics (eg, dicloxacillin or erythromycin 250 mg po qid) are
indicated when preseptal cellulitis accompanies a hordeolum.

Treatment of an internal hordeolum is oral antibiotics and incision and drainage if needed.
Topical antibiotics are usually ineffective.

Key Points
Chalazia and hordeola initially cause eyelid hyperemia and edema, swelling, and pain and
may be clinically indistinguishable for a few days.

A hordeolum remains painful and localizes to an eyelid margin.

Hot compresses can hasten resolution of either lesion.

Other treatments that may be needed include intralesional corticosteroids (for chalazia)
and incision and/or antibiotics (for hordeola).

Last full review/revision January 2018 by James Garrity, MD

© 2018 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA

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