How do you manage a hordeolum versus a chalazion?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: September 19, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Management of Hordeolum versus Chalazion

The management of hordeolum and chalazion should begin with warm compresses (10-15 minutes, 3-4 times daily) and eyelid hygiene as first-line treatment, with progression to more invasive treatments like intralesional steroid injection or incision and curettage for persistent cases. 1

Distinguishing Hordeolum from Chalazion

Hordeolum

  • Definition: Acute bacterial infection of the eyelid glands
  • Presentation: Painful, erythematous, localized swelling of the eyelid
  • Types:
    • External hordeolum (stye): Infection of Zeis or Moll glands
    • Internal hordeolum: Infection of meibomian glands
  • Symptoms: Pain, tenderness, redness, localized swelling

Chalazion

  • Definition: Chronic, non-infectious, granulomatous inflammation of meibomian glands
  • Presentation: Painless, firm nodule within the eyelid
  • Symptoms: Usually painless, slow-growing nodule, may cause astigmatism if large

Diagnostic Approach

  1. Clinical examination:

    • Assess for pain, redness, tenderness (suggests hordeolum)
    • Evaluate for firm, non-tender nodule (suggests chalazion)
    • Check for eyelid margin abnormalities and meibomian gland dysfunction 1
    • Perform slit lamp examination to evaluate lid margin and meibomian gland orifices

  2. Red flags requiring specialist referral:

    • Marked asymmetry between eyes
    • Resistance to standard therapy
    • Recurrent chalazia in same location
    • Loss of normal eyelid margin anatomy
    • Focal lash loss (madarosis) 1

Treatment Algorithm

First-Line Treatment (Both Conditions)

  • Warm compresses: Apply for 10-15 minutes, 3-4 times daily 1
  • Eyelid hygiene: Gentle cleansing of eyelid margins
  • Gentle massage: To promote drainage of blocked glands

Second-Line Treatment

  • For hordeolum:

    • Topical antibiotic ointment (bacitracin or erythromycin) if signs of infection 1
    • Avoid incision during acute phase

  • For chalazion:

    • Continue conservative treatment for 2-4 weeks
    • Consider topical antibiotic/steroid combination for moderate inflammation

Third-Line Treatment

  • For persistent hordeolum (>1 week with no improvement):

    • Consider oral antibiotics (doxycycline or azithromycin) for moderate-severe cases 1

  • For persistent chalazion (>2-4 weeks):

    • Intralesional corticosteroid injection (triamcinolone acetonide) 2
    • Incision and curettage for large or persistent lesions 1, 2

Special Considerations

Recurrent Chalazia

  • Evaluate for underlying conditions:
    • Meibomian gland dysfunction
    • Blepharitis
    • Rosacea
    • Consider subclinical hypothyroidism 3
    • Rule out sebaceous carcinoma (especially with multiple recurrences in same location) 1

Complications to Monitor

  • Secondary infection
  • Spread of infection to surrounding tissues
  • Visual changes due to induced astigmatism (large chalazia)
  • Transformation of hordeolum to chalazion if untreated

Prevention Strategies

  • Regular eyelid hygiene
  • Complete removal of eye makeup before sleeping
  • Treatment of underlying conditions (blepharitis, meibomian gland dysfunction)
  • Discontinuation of contact lens wear during active infection 1

When to Refer

  • Visual changes
  • Corneal involvement
  • Severe eyelid swelling unresponsive to initial treatment
  • Suspected malignancy (especially with recurrent chalazia in same location)
  • Cicatricial changes in the conjunctiva 1

Remember that while most hordeola resolve spontaneously within 7-10 days, chalazia may persist for weeks to months if not properly treated. Biopsy should be considered for atypical presentations or recurrent cases in the same location to rule out malignancy.

References

1
Guideline

Lower Eyelid Swelling Diagnosis and Management

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Related Questions

What is the difference between a chalazion and a stye?
What are the treatment options for chalazion and hordeolum?
What is the difference in treatment between a chalazion and a hordeolum (stye)?
What is the difference between a chalazion and a hordeolum in terms of causes, symptoms, and treatment?
Can a hordeolum (stye) turn into a chalazion?
What antibodies should be tested in patients with Postural Orthostatic Tachycardia Syndrome (POTS)?
What are the management options for ongoing flank pain after passing a kidney stone?
Is Solumedrol (Methylprednisolone) or Solucortef (Hydrocortisone) preferred for treating hypoglycemia?
Do all breech presentations at delivery require hip ultrasound at 6 weeks for developmental dysplasia of the hip (DDH) screening?
What are the criteria for surgical management of a hepatic abscess?
What are appropriate oral antibiotics for a possible infection at a bile drain site?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question