What is the difference between a chalazion and a hordeolum in terms of causes, symptoms, and treatment?

Chalazion vs Hordeolum: Differences in Causes, Symptoms, and Treatment

A chalazion is a non-inflammatory, painless, chronic lipogranulomatous cyst resulting from blocked meibomian glands, while a hordeolum (stye) is an acute, painful bacterial infection of the eyelid margin glands that requires different treatment approaches. 1

Key Differences

Etiology and Pathophysiology

• Chalazion:

  • Results from obstruction of meibomian glands (deep chalazion) or Zeis glands (superficial chalazion) 1
  • Non-infectious, sterile inflammatory response to retained sebaceous secretions 2
  • Often associated with meibomian gland dysfunction or posterior blepharitis 3
  • May develop following an unresolved internal hordeolum 4

• Hordeolum:

  • Bacterial infection (commonly Staphylococcal) of eyelid glands 5
  • Internal hordeolum: affects meibomian glands deeper in the eyelid 4
  • External hordeolum (stye): affects eyelash follicles or Zeis/Moll glands at the eyelid margin 1
  • Acute inflammatory process with purulent material 6

Clinical Presentation

• Chalazion:

  • Painless or mildly uncomfortable eyelid nodule 7
  • Develops gradually over weeks 1
  • Can occur on upper or lower eyelid 7
  • Non-erythematous unless secondarily infected 6
  • May cause localized swelling, mild discomfort, and cosmetic deformity 7
  • Can persist for months if untreated 7

• Hordeolum:

  • Painful, erythematous, localized swelling of eyelid margin 5
  • Develops rapidly (days) 4
  • Often has a visible purulent "head" pointing toward either the conjunctival or skin surface 6
  • May be associated with eyelid edema and conjunctival injection 5
  • Typically resolves within 7-10 days with or without treatment 4

Diagnostic Approach

• Chalazion:

  • Painless nodule within the tarsal plate 1
  • Visible meibomian gland obstruction on eyelid eversion 3
  • History of gradual onset 7
  • May be associated with history of blepharitis or meibomian gland dysfunction 3

• Hordeolum:

  • Painful, erythematous nodule at eyelid margin 5
  • Rapid onset with signs of acute inflammation 4
  • May have purulent discharge 6
  • Often associated with bacterial blepharitis 3

Treatment Approaches

Chalazion Management

• Conservative treatment (first-line):

  • Warm compresses (10-15 minutes, 3-4 times daily) to liquefy the thickened secretions 2
  • Eyelid massage to express the obstructed gland contents 3
  • Eyelid hygiene to address underlying blepharitis or meibomian gland dysfunction 7
  • May resolve spontaneously over several weeks to months 7

• Medical interventions:

  • Topical antibiotics (with or without steroids) may help if secondary infection is present 2
  • Intralesional steroid injection (triamcinolone acetonide) for persistent chalazia 2

• Surgical intervention:

  • Indicated for persistent chalazia (>2 months) or those causing significant symptoms 2
  • Incision and curettage under local anesthesia 2
  • Consider biopsy for recurrent chalazia in the same location or atypical presentations to rule out sebaceous carcinoma 7

Hordeolum Management

• Conservative treatment:

  • Warm compresses (10-15 minutes, 4-6 times daily) to promote drainage 4
  • Avoid squeezing or manipulating the lesion 5
  • Most resolve spontaneously within 7-10 days 4

• Medical interventions:

  • Topical antibiotics (e.g., bacitracin, erythromycin) if spreading infection is suspected 5
  • Oral antibiotics rarely needed unless cellulitis develops 4

• Surgical intervention:

  • Incision and drainage may be considered for persistent, painful hordeola that don't drain spontaneously 5

Important Clinical Considerations

• Warning signs requiring further evaluation:

  • Recurrent chalazia in the same location (consider sebaceous carcinoma) 7
  • Unilateral chronic blepharitis unresponsive to therapy (consider carcinoma) 3
  • Loss of eyelashes (madarosis) in the affected area 3
  • Atypical clinical appearance or progression 6

• Special populations:

  • Children with chalazia may have underlying chronic blepharokeratoconjunctivitis requiring evaluation by an ophthalmologist 7
  • Patients with recurrent chalazia should be evaluated for underlying conditions like meibomian gland dysfunction, rosacea, or seborrheic dermatitis 3

• Prevention strategies:

  • Regular eyelid hygiene for patients with blepharitis or meibomian gland dysfunction 3
  • Treatment of underlying skin conditions (rosacea, seborrheic dermatitis) 3
  • Avoiding eye makeup during active inflammation 3