What is the difference between a chalazion and a stye?

Difference Between Chalazion and Stye (Hordeolum)

A chalazion is a gradual, usually painless, firm round nodule caused by retained secretions in the meibomian glands, while a hordeolum (stye) is an acute, painful, red, swollen, pointed lesion caused by bacterial infection of the eyelid glands. 1

Key Differences

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

Detailed Comparison

Hordeolum (Stye)

• Definition: An acute purulent localized swelling of the eyelid 2
• Types:
  • External hordeolum: Affects eyelash follicle, Zeis gland, or Moll gland
  • Internal hordeolum: Affects meibomian glands deeper in the eyelid
• Presentation:
  • Acute onset
  • Painful, red, swollen, pointed appearance
  • Often has a visible "head" of purulent material
  • May cause localized eyelid edema
• Complications: Can progress to chalazion if untreated, spread infection to adjacent tissues, or rarely lead to eyelid necrosis or cellulitis 1

Chalazion

• Definition: A localized cyst of chronic lipogranulomatous inflammation 2
• Types:
  • Deep chalazion: Arises from meibomian gland
  • Superficial chalazion: Arises from Zeis gland
• Presentation:
  • Gradual onset
  • Usually painless
  • Firm, round nodule appearance
  • May cause astigmatism or reduced vision if large and pressing on cornea
• Associations: May be associated with conditions like meibomian gland dysfunction, rosacea, and subclinical hypothyroidism 3

Management Approaches

Hordeolum (Stye)

1. First-line treatment:

   • Warm compresses applied to eyelids for several minutes, 1-2 times daily 1
   • Gentle cleansing of eyelid margins to remove crusting using diluted baby shampoo or commercial eyelid cleaner
   • Antibiotic ointment (bacitracin or erythromycin) applied to eyelid margins 1+ times daily

2. When to refer:

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

Chalazion

1. First-line treatment:

   • Warm compresses and lid hygiene (similar to hordeolum)
   • May resolve spontaneously with conservative treatment

2. Second-line treatment:

   • Intralesional steroid injections (triamcinolone acetonide)
   • Incision and curettage for persistent lesions 4

3. When to refer:

   • Recurrent chalazia in the same location (especially in elderly patients)
   • Marked asymmetry
   • Resistance to therapy 1

Important Clinical Considerations

• Recurrent lesions: Recurrent chalazia in the same location, especially in elderly patients, require ophthalmology referral to rule out sebaceous carcinoma 1

• Underlying conditions: Recurrent chalazia or hordeola may indicate:

  • Meibomian gland dysfunction
  • Blepharitis
  • Rosacea
  • Subclinical hypothyroidism 3
  • In children: chronic blepharokeratoconjunctivitis 1

• Prevention: Early intervention with warm compresses and lid hygiene, addressing underlying conditions, and completing the full treatment course can help prevent hordeola from transforming into chalazia 1

Common Pitfalls to Avoid

• Failing to recognize that untreated hordeola can progress to chalazia
• Using compresses that are too hot, which may burn the skin
• Aggressive eyelid manipulation in patients with advanced glaucoma or filtering procedures 1
• Mistaking sebaceous carcinoma for recurrent chalazia, particularly in older patients
• Not addressing underlying systemic conditions that may contribute to recurrence