Chalazion vs Stye: Key Differences
A stye (hordeolum) is a painful, rapidly developing infection at the eyelid margin with purulent discharge, while a chalazion is a painless, slowly developing nodule within the tarsal plate caused by meibomian gland obstruction.
Distinguishing Features
Stye (Internal Hordeolum)
- Painful, erythematous nodule at the eyelid margin with acute inflammation and rapid onset 1, 2
- Purulent discharge is commonly present 1
- Associated with bacterial infection (typically staphylococcal) and bacterial blepharitis 1
- Most cases resolve spontaneously within 5-14 days 1
Chalazion
- Painless nodule within the tarsal plate with gradual onset 1, 2
- Visible meibomian gland obstruction on eyelid eversion 1
- Associated with meibomian gland dysfunction, posterior blepharitis, rosacea, or seborrheic dermatitis 1, 3
- Can persist for months but may resolve spontaneously 1
- If moderate to severe pain develops in a presumed chalazion, this requires immediate ophthalmologic evaluation as it may indicate secondary infection or atypical presentation 3
Treatment Approaches
Stye (Internal Hordeolum) Management
- First-line: Warm compresses for 10-15 minutes, 3-4 times daily, combined with topical antibiotic drops or ointment 1
- Gentle massage after warm compresses to promote spontaneous drainage 2
- Institute regular eyelid hygiene measures 1
- Note: Evidence for hordeolum treatment is notably weak, based primarily on expert consensus 1, 4, 5
Chalazion Management
- Start with warm compresses for 5-10 minutes, 3-4 times daily, combined with eyelid hygiene 3, 2
- Gentle massage after compresses to express the obstructed gland 3
- Do not continue conservative management beyond 4-6 weeks without reassessment, as this delays diagnosis of potential malignancy 3, 2
- For persistent chalazia after 4-6 weeks: intralesional triamcinolone acetonide injection (93.8% success rate vs 58.3% with conservative management alone) 3
- Surgical excision if unresponsive to conservative and injection therapy 6
Critical Red Flags Requiring Biopsy
Always biopsy chalazia with these features to exclude sebaceous carcinoma:
- Recurrence in the same location, especially in elderly patients 1, 3, 2
- Marked asymmetry or resistance to standard therapy 3, 2
- Atypical features: eyelid margin distortion, focal lash loss (madarosis), or ulceration 1, 3, 2
- Unilateral chronic blepharitis unresponsive to therapy 1, 2
- History of multiple excisions at the same site 1
Common Pitfalls to Avoid
- Mistaking a painful chalazion for a typical presentation - moderate to severe pain warrants immediate ophthalmologic evaluation 3
- Prolonged conservative management without reassessment - delays diagnosis of sebaceous carcinoma masquerading as chalazion 3, 2
- Failing to address underlying conditions - treat bacterial blepharitis, meibomian gland dysfunction, rosacea, or seborrheic dermatitis before addressing the lesion 3, 2
- Hypopigmentary skin changes can occur at intralesional steroid injection sites 3
Prevention Strategies
- Regular eyelid hygiene for patients with blepharitis or meibomian gland dysfunction 1, 3, 2
- Treat underlying skin conditions (rosacea, seborrheic dermatitis) 1, 3, 2
- Avoid eye makeup during active inflammation 1, 3, 2