Hordeolum (Stye) & Chalazion

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Hordeolum (stye) and chalazion (pronounced "kuh-LAY-zee-on") are both inflammatory lesions that occur at or near the rim of the eyelid. 

In general, hordeola are acute, infected, and painful lesions at the rim of the eyelid. Chalazia are subacute or chronic, noninfected, and generally less painful lesions on the conjunctival side of the eyelid.

Hordeola (see “stye” section below) can be divided into internal and external hordeola based on their location.  Styes, or external hordeola, are the most common and occur at the margin of the eyelid. 


Chalazion

Definition: Firm, nontender nodular lesion of the eyelid resulting from obstruction and subsequent chronic granulomatous inflammation of a Zeis or meibomian gland.

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http://dro.hs.columbia.edu/chalazion.htm

Etiology: Normally, sebaceous meibomian glands of the eyelid produce an oily substance (meibum) that forms the hydrophobic lipid layer of the tear film.  If these glands become obstructed, a cyst with concurrent granulomatous inflammation can form, representing a chalazion, also known as a meibomian gland lipogranuloma.  Sebaceous glands of Zeis, which serve to support eyelash follicles at the rim of the eyelid, can also become obstructed and lead to chalazion formation. 

Often, chalazia can form from inflamed hordeola (see “stye” section) that scar and harden with time.  Also, chalazia can often be seen in patients with blepharitis of the eyelid margin and in those with rosacea.

 

PresentationChalazia may first present with eyelid swelling and erythema, eventually evolving into a painless, rubbery, nodular lesion.  Chalazia resulting from meibomian gland obstruction occur on the inner (conjunctival) side of the eyelid.

 

Signs and symptoms include:

  • Swelling on the eyelid
  • Eyelid tenderness
  • Sensitivity to light
  • Increased tearing
  • Heaviness of the eyelid

 

A chalazion may be mistaken for a hordeolum (stye) but can be differentiated by its subacute to chronic onset, slower growth, relative non-tenderness, and location on inner eyelid (not generally at eyelid margin like styes).  Also, chalazia are generally larger than styes at the time of presentation.

 

Complications: A chalazion is a relatively benign lesion.  Nevertheless, large chalazia can exert pressure on the cornea leading to astigmatism. Small chalazia on the inner eyelid can exert enough pressure to deform a weakened cornea in patients following laser eye surgery.  Finally, although rare, sebaceous cell carcinoma and other cancers can be evidenced by chalazia that recur in the same area.

 

Management:  Chalazion is a granulomatous, non-infectious condition, thus antibiotics are not indicated.  Frequently, a small chalazion will resolve on its own.  Even most large chalazia will spontaneously clear in weeks to months.  Clearance may be helped by the use of frequent hot compresses (warm, wet compresses 5-10 minutes, 3-6 times per day).  Chalazia should not be squeezed or lanced by the patient. 

If a lesion is recalcitrant and/or persistently symptomatic, referral to an ophthalmologist can be made for further treatment by surgical incision and curettage or direct glucocorticoid injection.  Persistent or recurring chalazia should be checked histopathologically for possible sebaceous cell, basal cell, or meibomian gland carcinoma.

 


Stye (hordeolum)       

 Definition: Acute, purulent inflammation of the glands or eyelash follicles of the eyelid.  The term stye generally refers to external hordeola, those arising from eyelash follicles or tear glands at the lid margin (as opposed to meibomian glands under the conjunctival side of the eyelid, which is where internal hordeola and chalazia tend to occur).

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https://en.wikipedia.org/wiki/Stye

 

Etiology: Hordeola may be sterile, but often contain inflammatory cells as well as bacteria, most commonly Staphylococcus aureus, which gain access to meibomian glands (internal hordeolum) or eyelash follicles or glands of Zeis (external hordeolum, or stye), leading to an acute, purulent, painful inflammation of the eyelid.

 

Presentation:  Styes begin as small red bumps with yellow spots at their center as pus expands.  They look like a pimple along the edge of the eyelid.  They continue to swell (~3 days) until they break open and drain.    

Signs and symptoms include: lump on eyelid, localized swelling, localized pain/tenderness, redness, crusting of eyelid margins, droopy eyelid, blurred vision, tearing and/or mucous discharge, light sensitivity

 

Hordeola can be differentiated from chalazia by their acute onset, fast growth, exquisite tenderness, and location at the lid margin.  Over time, hordeola may harden into chalazia.

 

Complications: Rare complications include progression to chalazion and/or periorbital cellulitis.

 

Management: Most hordeola will heal spontaneously within 1-2 weeks, after swelling, breaking open, and draining on their own.  Warm compresses (15 minutes, four times per day) can assist with drainage and resolution of these lesions.  Styes should not be squeezed or opened by the patient. 

Good eyelid hygiene, including avoidance of eye makeup and contact lenses until the lesion has healed, is important for early resolution.  See “chalazion” section for management of styes that do not respond to warm compresses within 1-2 weeks and harden into chalazia. 

There is little evidence that topical medications help to promote healing in most cases of hordeolum.  However, a combination of topical antibiotics and corticosteroids may be beneficial in patients with frequent hordeola in the setting of rosacea-associated blepharitis and who have not found relieve with warm compresses.  These patients probably should be managed by an ophthalmologist, as topical steroid use around the eye can contribute to long-term ocular complications.

Oral antibiotics (with Staphylococcal coverage) are appropriate only for cases with concurrent periorbital cellulitis.

 


 Prevention:  The following measures can be taken to reduce the risk of hordeola (styes) or chalazia:

  •  Avoid rubbing eyes
  • Wash hands before touching eyes
  • Wash hands before putting in contact lenses; keep lenses clean
  • Protect eyes from dust and air pollution
  • Replace eye makeup (mascara!) every 6 months (bacteria can grow in makeup
  • Do not share makeup
  • If recurrent styes or chalazia, wash eyelids regularly with warm water and baby shampoo

 

 References

Ben Simon GJ, Huang L, Nakra T, et al. Intralesional triamcinolone acetonide injection for primary and recurrent chalazia: is it really effective? Opthalmology 2005; 112:913.

Ghosh C, Ghosh T, Trobe J, Lin FH. “Eyelid lesions.” UpToDate. www.uptodate.com. Accessed 21 October 2012.

Lindsley K, Nichols JJ, Dickersin K. Interventions for acute internal hordeolum. Cochran Database Syst Rev 2012; CD00742.

 “Patient information: Chalazion (The Basics). UpToDate. www.uptodate.com.  Accessed 21 October 2012.

“Patient information: Stye (hordeolum) (The Basics). UpToDate. www.uptodate.com. Accessed 21 October 2012.

Skorin, L.  “Hordeolum and chalazion treatment: the full gamut.” www.optometry.co.uk, June 28, 2002.