Is a Chalazion Always Painful?
No, a chalazion is typically painless—it presents as a painless nodule within the tarsal plate, distinguishing it from a hordeolum (stye), which is characteristically painful with acute inflammation. 1
Key Clinical Distinction
A chalazion is fundamentally a non-inflammatory process caused by retained secretion of the meibomian or Zeis glands, not an acute infection. 2 This pathophysiology explains why pain is not a typical feature:
- Chalazion characteristics: Painless nodule, gradual onset, associated with meibomian gland obstruction visible on eyelid eversion, and may cause mild discomfort or localized swelling but not significant pain 1
- Hordeolum characteristics (the painful counterpart): Painful, erythematous nodule at eyelid margin, rapid onset with acute inflammation, purulent discharge, often associated with bacterial blepharitis 1
When Pain Suggests Something Else
If a presumed chalazion is causing moderate to severe pain, this warrants immediate ophthalmologic evaluation as it may indicate:
- An acute hordeolum (internal or external stye) rather than a chalazion 1
- Secondary infection or inflammation 1
- Atypical presentation requiring further investigation 3
The American Academy of Ophthalmology specifically recommends that patients, particularly children, with eyelid lesions should be evaluated by an ophthalmologist if there is moderate or severe pain, visual loss, or severe/chronic redness. 3
Clinical Pitfall to Avoid
Do not assume all painless eyelid nodules are benign chalazia. Sebaceous carcinoma may masquerade as a recurrent chalazion and is also typically painless. 3 Always biopsy chalazia with:
- Recurrence in the same location, especially in elderly patients 4
- Atypical features including eyelid margin distortion, focal lash loss, or ulceration 4
- Resistance to standard therapy after 4-6 weeks 4
The absence of pain does not guarantee benignity—it's the chronicity, recurrence pattern, and response to treatment that matter most for distinguishing chalazion from malignancy.