From the Guidelines
A chalazion and hordeolum (stye) are distinct eyelid conditions with different causes and presentations, requiring prompt diagnosis and treatment to prevent complications such as cellulitis, preseptal cellulitis, and corneal irritation. The key difference between the two conditions lies in their etiology, with a chalazion being a painless, slow-growing nodule caused by blockage of meibomian glands, and a hordeolum being a painful, red, acute infection of either the meibomian glands or the glands of Zeis or Moll 1.
Clinical Presentation and Diagnosis
- A chalazion typically presents as a painless, slow-growing nodule on the eyelid, often caused by blockage of meibomian glands.
- A hordeolum, on the other hand, is a painful, red, acute infection, which can be internal (involving meibomian glands) or external (involving glands of Zeis or Moll).
- Diagnosis is primarily clinical, based on the presentation and characteristics of the eyelid lump, and may involve assessment of lid margin changes and expression of the meibomian glands, as well as interferometry technology to evaluate the tear film lipid-layer thickness and blink dynamics 1.
Complications
- Both conditions can lead to complications such as cellulitis, preseptal cellulitis, corneal irritation, astigmatism from pressure on the cornea, and rarely, systemic spread of infection.
- It is essential to consider the possibility of carcinoma, especially in patients with chronic blepharitis unresponsive to therapy, and to perform a biopsy to exclude the possibility of carcinoma in cases of marked asymmetry, resistance to therapy, or unifocal recurrent chalazia that do not respond well to therapy 1.
Treatment
- Warm compresses applied for 10-15 minutes, 4-6 times daily are the first-line therapy for both conditions, helping to promote drainage and reduce inflammation.
- Hordeola often respond to antibiotic ointments like erythromycin or bacitracin applied to the lid margin 2-4 times daily for 7-10 days.
- Chalazia that persist beyond 2-4 weeks may require intralesional steroid injection (triamcinolone 0.1-0.2 mL) or surgical incision and curettage under local anesthesia.
- Oral antibiotics like doxycycline 100mg twice daily for 7-10 days may be needed for severe or recurrent cases, especially with signs of spreading infection.
- Good eyelid hygiene with gentle cleansing and avoiding eye makeup during active infections helps prevent recurrence, and patients with diabetes or immunocompromised conditions should seek prompt medical attention as they're at higher risk for complications.
From the Research
Difference between Chalazion and Hordeolum
- A chalazion and a hordeolum are both inflammatory eyelid tumors, but they have distinct characteristics 2.
- They can occur in association with underlying diseases causing Meibomian gland dysfunction and/or chronic blepharitis 2.
Complications
- In persistent, recurrent, or clinically atypical cases, malignant tumors must be excluded as a differential diagnosis by excisional biopsy and histopathological assessment 2.
- If left untreated, chalazia and hordeola can lead to further complications, but the majority of these lesions resolve spontaneously over time 2.
Treatment
- The diagnosis of hordeolum and chalazion can mostly be clinically established due to their typical morphological features and clinical course 2.
- Surgical intervention is sometimes unavoidable, especially in cases where the lesions do not resolve on their own 2.
- The use of antibiotics is common in the treatment of chalazia and hordeola, but studies have shown that it does not significantly improve the efficacy of care 3.
- A study found that the addition of an antibiotic to conservative measures for a chalazion or hordeolum was not associated with an increased likelihood of treatment success 3.