Which organism is the usual cause of a stye (hordeolum)?

Staphylococcus aureus A stye is an acute infection of an eyelid gland, usually caused by Staphylococcus aureus.

How is a chalazion defined?

Chronic granulomatous inflammation of a blocked meibomian gland A chalazion follows leakage of oil from a blocked meibomian gland into surrounding tissue; it is not an infection, so antibiotics rarely help.

An acute staphylococcal abscess of a lash follicle

A retention cyst of an accessory lacrimal gland

A benign papilloma of the lid margin

An external stye involves which eyelid glands?

The glands of the lash follicles External styes involve the lash follicle glands and sit at the lid margin near a lash; internal styes involve the meibomian glands.

The accessory lacrimal glands of Krause

A tender, red eyelid lump appeared two days ago at the lash margin with a yellow head; what is the likely diagnosis?

Stye A stye is tender and painful from the start, develops over days and shows a pustule or yellow head, whereas a chalazion is a slow, painless, firm nodule.

Where is a chalazion typically located, compared with an external stye?

Deeper in the tarsal plate, away from the margin Chalazia sit deeper in the tarsal plate and may point toward the conjunctival side, so the lid should be everted to see the lesion.

On the bulbar conjunctiva near the limbus

At the lid margin beside a lash

When are antibiotics appropriate for a stye?

For every stye at first presentation

When a stye has drained within a week

When the lump becomes painless and firm

Which side effect of steroid injection for a persistent chalazion is a concern in dark-skinned patients?

Skin depigmentation Steroid injection or incision and curettage can treat a persistent chalazion, but steroid can depigment the skin in dark-skinned patients.

Which malignancy can mimic a chalazion that recurs at the same site?

Sebaceous carcinoma Sebaceous carcinoma is rare but dangerous and can mimic a chronic chalazion, so recurrent or atypical lesions should be biopsied.

Why should patients never squeeze or pop a stye?

Squeezing can spread infection into the orbit Squeezing a stye can spread infection into the orbit; suspected orbital spread with fever or proptosis needs referral.

It turns the stye into a chalazion

Unexplained recurrent styes in an adult should prompt which systemic check?

Blood glucose Adults with diabetes and rosacea get these lesions more often, so recurrent lesions prompt a metabolic check, including glucose for unexplained recurrent styes.

Stye vs Chalazion: How to Tell Them Apart

Stye vs chalazion is a question patients ask almost daily.

Both appear as a lump on the eyelid, but they differ in cause and course.

Telling them apart guides the right treatment.

What Is a Stye

A stye, or hordeolum, is an acute infection of an eyelid gland.

Staphylococcus aureus is the usual cause (see hordeolum and stye).

External styes involve the lash follicle glands.

Internal styes involve the meibomian glands.

What Is a Chalazion

A chalazion is a chronic granulomatous inflammation of a blocked meibomian gland.

It follows leakage of oil into the surrounding tissue.

It is not an infection (see chalazion).

Therefore, antibiotics rarely help.

Test your knowledge 10 questions from this article

Stye vs Chalazion by Pain

A stye is tender, red and painful from the start.

A chalazion is usually painless after the first few days.

Pain therefore points toward a stye.

However, an acute chalazion can be tender.

Stye vs Chalazion by Location

External styes sit at the lid margin near a lash.

Chalazia sit deeper in the tarsal plate, away from the margin.

Also, a chalazion may point toward the conjunctival side.

So evert the lid to see the lesion.

Stye vs Chalazion by Time Course

A stye develops over a few days and often drains within a week.

A chalazion grows slowly over weeks.

It may persist for months without treatment.

Therefore, ask how long the lump has been present.

Appearance on Examination

A stye shows a pustule or yellow head with surrounding redness.

A chalazion appears as a firm, round, non-tender nodule.

The overlying skin is usually normal.

Also, check for loss of lashes.

Initial Treatment

Both conditions respond to warm compresses.

Apply them for ten minutes, three to four times daily.

Gentle massage after the compress helps drainage.

Also, keep the eyelid clean (see blepharitis).

When Antibiotics Help

Antibiotics suit a stye with spreading cellulitis.

Topical drops do little for a deep internal stye.

Also, they do not treat a chalazion.

Therefore, avoid reflex prescribing.

Options for a Persistent Chalazion

Steroid injection can shrink a persistent lesion.

Incision and curettage is another choice.

However, the choice depends on size and patient preference.

Also, steroid can depigment the skin in dark-skinned patients.

Recurrence and Underlying Disease

Recurrent lesions suggest blepharitis, rosacea or meibomian gland dysfunction.

Treat these causes to prevent new lumps.

Also consider biopsy for a lesion that recurs at the same site.

Sebaceous carcinoma can mimic a chalazion.

Stye vs Chalazion: How to Tell Them Apart

When to Refer

Refer lesions with loss of lashes, distortion or bleeding.

Refer suspected orbital spread with fever or proptosis.

Also refer children with a lesion that blocks the visual axis.

Therefore, give clear return advice.

Pitfalls to Avoid

Do not prescribe antibiotics for a simple chalazion
Never squeeze a stye
Avoid skipping biopsy in recurrent lesions
Do not forget to examine the lash line

Stye vs Chalazion in Children

Children get both lesions, often with blepharitis.

Parents should apply warm compresses with care.

Surgery may need sedation in young children.

Therefore, choose conservative care first.

Stye vs Chalazion in Adults

Adults with rosacea and diabetes get both more often.

Recurrent lesions should prompt a metabolic check.

Check glucose in unexplained recurrent styes.

Also screen for rosacea.

Warm Compress Technique

Use a clean cloth soaked in warm water.

Hold it on the closed lid for ten minutes.

Repeat three to four times daily.

Never use a compress that burns the skin.

What Not to Do

Do not squeeze or pop a stye.

Squeezing can spread infection into the orbit.

Avoid wearing eye make-up during an active lesion.

Also avoid contact lenses until it settles.

Pathology and Biopsy

Send tissue from recurrent or atypical lesions for pathology.

Sebaceous carcinoma can mimic chronic chalazion.

It is rare but dangerous.

So a high index of suspicion helps.

Recurrence After Treatment

Recurrence is common without lid care.

Combine treatment of the lesion with eyelid hygiene.

Also treat the underlying meibomian gland disease.

Therefore, follow the patient until the lids are quiet.

Stye vs Chalazion: Patient Questions

Patients ask whether the lump will go away on its own.

Many styes drain within a week, and some chalazia fade over weeks to months.

They also ask whether the lump is contagious.

A stye is not spread by casual contact.

Practical Summary

If the lump is painful and recent, think of a stye.

When it is painless and slow, think of a chalazion.

However, remember that both respond to warm compresses.

Because recurrence is common, advise lid care.

Therefore, review the patient if the lump persists for more than a month.

Finally, biopsy any lesion that looks atypical.

References

Lindsley K, Nichols JJ, Dickersin K. Non-surgical interventions for acute internal hordeolum. Cochrane Database Syst Rev. 2017;1:CD007742.
Wu AY, Gervasio KA, Gergoudis KN, et al. Conservative therapy for chalazia: is it really effective? Acta Ophthalmol. 2018;96:e514-e517.
Carlisle RT, Digiovanni J. Differential diagnosis of the swollen red eyelid. Am Fam Physician. 2015;92:106-112.
Shields JA, Shields CL. Eyelid, Conjunctival, and Orbital Tumors: An Atlas and Textbook. 3rd ed. Wolters Kluwer; 2016.

Test yourself

A few questions straight from this article.

1 / 10 0 correct

Which organism is the usual cause of a stye (hordeolum)?
A stye is an acute infection of an eyelid gland, usually caused by Staphylococcus aureus.
How is a chalazion defined?
A chalazion follows leakage of oil from a blocked meibomian gland into surrounding tissue; it is not an infection, so antibiotics rarely help.
An external stye involves which eyelid glands?
External styes involve the lash follicle glands and sit at the lid margin near a lash; internal styes involve the meibomian glands.
A tender, red eyelid lump appeared two days ago at the lash margin with a yellow head; what is the likely diagnosis?
A stye is tender and painful from the start, develops over days and shows a pustule or yellow head, whereas a chalazion is a slow, painless, firm nodule.
Where is a chalazion typically located, compared with an external stye?
Chalazia sit deeper in the tarsal plate and may point toward the conjunctival side, so the lid should be everted to see the lesion.
When are antibiotics appropriate for a stye?
Antibiotics suit a stye with spreading cellulitis; topical drops do little for a deep internal stye and do not treat a chalazion.
Which side effect of steroid injection for a persistent chalazion is a concern in dark-skinned patients?
Steroid injection or incision and curettage can treat a persistent chalazion, but steroid can depigment the skin in dark-skinned patients.
Which malignancy can mimic a chalazion that recurs at the same site?
Sebaceous carcinoma is rare but dangerous and can mimic a chronic chalazion, so recurrent or atypical lesions should be biopsied.
Why should patients never squeeze or pop a stye?
Squeezing a stye can spread infection into the orbit; suspected orbital spread with fever or proptosis needs referral.
Unexplained recurrent styes in an adult should prompt which systemic check?
Adults with diabetes and rosacea get these lesions more often, so recurrent lesions prompt a metabolic check, including glucose for unexplained recurrent styes.

Ahmed Ophthalmologist

Writes and reviews the clinical articles on Educate. Every post is checked against peer-reviewed sources before it goes live.