What are the treatment options for a chalazion versus a stye?

Chalazion vs. Stye: Diagnosis and Treatment

The first-line treatment for both chalazia and hordeola (styes) is warm compresses and eyelid hygiene, but chalazia may require additional interventions such as intralesional steroid injection or incision and curettage if they persist beyond 4-6 weeks of conservative management. 1

Distinguishing Chalazion from Hordeolum (Stye)

Characteristic	Hordeolum (Stye)	Chalazion
Onset	Acute	Gradual
Pain	Painful	Usually painless
Appearance	Red, swollen, pointed	Firm, round nodule
Etiology	Bacterial infection	Retained secretions
Location	At lid margin (external) or within tarsus (internal)	Within tarsus

Treatment Algorithm

First-Line Treatment for Both Conditions:

1. Warm compresses

   • Apply to eyelids for several minutes, 1-2 times daily 2
   • Use hot tap water on clean washcloth, commercial heat pack, or homemade bean/rice bag heated in microwave 2
   • Caution: Avoid temperatures that could burn the skin 2
   • The Re-Heater or hard-boiled egg methods provide better heat retention than warm washcloths 3

2. Eyelid cleansing and massage

   • For chalazia: Vertical massage to express meibomian secretions 2
   • For styes: Gentle cleansing of eyelid margins to remove crusting 2
   • Use diluted baby shampoo or commercial eyelid cleaner on cotton ball/swab 2
   • Hypochlorous acid 0.01% cleaners have strong antimicrobial effects for anterior blepharitis 2

Additional Treatment for Hordeola (Styes):

• Topical antibiotics
  • Antibiotic ointment (bacitracin or erythromycin) applied to eyelid margins 1+ times daily 2
  • Continue for a few weeks as needed 2

Additional Treatment for Persistent Chalazia:

If no improvement after 4-6 weeks of conservative treatment:

1. Intralesional steroid injection

   • Triamcinolone acetonide injection (0.2 mL of 10 mg/mL) 4
   • Resolution rates of approximately 84% 4
   • Less painful and less inconvenient than surgical options 4
   • Most effective for non-infected chalazia 5

2. Incision and curettage

   • Resolution rates of approximately 87% 4
   • Method of choice for infected chalazia 5
   • More painful than steroid injection but equally effective 4

Special Considerations

When to Refer to Ophthalmology:

• Visual loss
• Moderate or severe pain
• Severe or chronic redness
• Recurrent chalazia in the same location
• No improvement after 4-6 weeks of conservative treatment 1

Red Flags Requiring Biopsy:

• Recurrent chalazia in the same location
• Marked asymmetry
• Resistance to therapy
• Elderly patients (consider sebaceous carcinoma) 1

Associated Conditions:

• Recurrent chalazia may be associated with:
  • Meibomian gland dysfunction
  • Subclinical hypothyroidism 6
  • Blepharokeratoconjunctivitis (especially in children) 1

Treatment Efficacy

• Conservative treatment alone resolves approximately 46% of chalazia 4
• Intralesional triamcinolone and surgical incision/curettage have similar success rates (84% vs 87%) 4
• Patient satisfaction is significantly higher with active interventions compared to conservative management alone 4

Pitfalls to Avoid

• Failing to recognize that untreated hordeola can progress to chalazia 1
• Using compresses that are too hot and may burn the skin 2
• Aggressive eyelid manipulation in patients with advanced glaucoma or filtering procedures 2
• Missing underlying conditions in cases of recurrent chalazia 1, 6
• Delaying referral for persistent or recurrent lesions 1