A chalazion is noninfectious obstruction of a meibomian gland causing extravasation of irritating lipid material in the eyelid soft tissues with focal secondary granulomatous inflammation. Disorders that cause abnormally thick meibomian gland secretions (eg, meibomian gland dysfunction, acne rosacea) increase the risk of meibomian gland obstruction.
A hordeolum (stye) is an acute, localized swelling of the eyelid that may be external or internal and usually is a pyogenic (typically staphylococcal) infection or abscess. Most hordeola are external and result from obstruction and infection of an eyelash follicle and adjacent glands of Zeis or Moll glands. Follicle obstruction may be associated with blepharitis Blepharitis Blepharitis is inflammation of the eyelid margins that may be acute or chronic. Symptoms and signs include itching and burning of the eyelid margins with redness and edema. Diagnosis is by history... read more . An internal hordeolum, which is very rare, results from infection of a meibomian gland. Sometimes cellulitis Preseptal and Orbital Cellulitis Preseptal cellulitis (periorbital cellulitis) is infection of the eyelid and surrounding skin anterior to the orbital septum. Orbital cellulitis is infection of the orbital tissues posterior... read more accompanies hordeola.
Symptoms and Signs of Chalazion and Hordeolum
Chalazia and hordeola each cause eyelid redness, swelling, and pain.
Initially the eyelid is diffusely swollen. Occasionally the eyelid can be massively swollen, shutting the eye completely. After 1 or 2 days, a chalazion localizes to the body of the eyelid. Typically, a small nontender nodule or lump develops. A chalazion usually drains through the inner surface of the eyelid or is absorbed spontaneously over 2 to 8 weeks; rarely, it persists longer. Depending on its size and location, a chalazion may indent the cornea, resulting in slightly blurred vision.
After 1 to 2 days, an external hordeolum localizes to the eyelid margin. There may be tearing, photophobia, and a foreign body sensation. Typically, a small yellowish pustule develops at the base of an eyelash, surrounded by hyperemia, induration, and diffuse edema. Within 2 to 4 days, the lesion ruptures and discharges material (often pus), thereby relieving pain and resolving the lesion.
Symptoms of an internal hordeolum are the same as those of a chalazion, with pain, redness, and edema localized to the posterior tarsal conjunctival surface. Inflammation may be severe, sometimes with fever or chills. Inspection of the tarsal conjunctivae shows a small elevation or yellow area at the site of the affected gland. Later, an abscess forms. Spontaneous rupture is rare; however, when it does occur, it usually occurs on the conjunctival side of the eyelid and sometimes erupts through the skin side. Recurrence is common.
Diagnosis of Chalazion and Hordeolum
Diagnosis of chalazion and both kinds of hordeola is clinical; however, during the first 2 days, they may be clinically indistinguishable. Because internal hordeola are so rare, they are not usually suspected unless inflammation is severe or fever or chills are present. If the chalazion or hordeolum lies near the inner canthus of the lower eyelid, it must be differentiated from dacryocystitis Dacryocystitis Dacryocystitis is infection of the lacrimal sac that sometimes leads to abscess formation. The usual cause is a staphyloccocal or streptococcal species, typically as a consequence of nasolacrimal... read more and canaliculitis Canaliculitis Canaliculitis is inflammation of the canaliculus. The most common cause of canaliculitis is infection with Actinomyces israelii, a gram-positive bacillus with fine branching filaments... read more , which can usually be excluded by noting the location of maximum induration and tenderness (eg, eyelid for a chalazion, under the medial canthus near the side of the nose for dacryocystitis, and over the punctum for canaliculitis).
Chronic chalazia that do not respond to treatment require biopsy to exclude tumor of the eyelid.
Treatment of Chalazion and Hordeolum
Sometimes drainage or drug therapy, such as corticosteroid injection (for chalazia) or oral antibiotics (for hordeola)
Warm compresses for 5 to 10 minutes 2 or 3 times a day can be used to hasten resolution of chalazia and external hordeola.
Incision and curettage or intrachalazion corticosteroid therapy (0.05 to 0.2 mL triamcinolone 25 mg/mL) may be indicated if chalazia are large, unsightly, and persist for more than several weeks despite conservative therapy.
An external hordeolum that does not respond to hot compresses can be incised with a sharp, fine-tipped blade. Systemic antibiotics (eg, dicloxacillin or erythromycin 250 mg orally 4 times a day) are indicated when preseptal cellulitis Preseptal and Orbital Cellulitis Preseptal cellulitis (periorbital cellulitis) is infection of the eyelid and surrounding skin anterior to the orbital septum. Orbital cellulitis is infection of the orbital tissues posterior... read more accompanies a hordeolum.
Treatment of an internal hordeolum is oral antibiotics and incision and drainage if needed. Topical antibiotics are usually ineffective.
Chalazia and hordeola initially cause eyelid hyperemia and edema, swelling, and pain and may be clinically indistinguishable for a few days.
A hordeolum remains painful and localizes to an eyelid margin.
Hot compresses can hasten resolution of either lesion.
Other treatments that may be needed include intralesional corticosteroids (for chalazia) and incision and/or antibiotics (for hordeola).
Consider biopsy to exclude eyelid tumor for chronic chalazia that do not respond to usual treatments.