Stye and Chalazion
Summary/Definition
A stye (hordeolum) is an acute purulent inflammation caused by a bacterial infection of the glands of the eyelid, typically resulting in swelling and pus accumulation. Depending on the location of the inflamed gland, if the inflammation occurs in the Zeis or Moll glands located on the outer part of the eyelid, it is called an external stye (external hordeolum). If the inflammation occurs in the Meibomian gland located on the inner part of the eyelid, it is called an internal stye (internal hordeolum). It is primarily caused by an infection with Staphylococcus aureus. It appears as a small tumor-like swelling on the edge of the eyelid or around the base of the eyelashes. It is more likely to occur when the gland’s ducts are blocked or secretion is delayed due to various reasons.
A chalazion is a chronic granulomatous inflammation that occurs not due to a bacterial infection, but because the duct of the Meibomian gland is blocked, causing the oily substance to seep into the tarsal plate and surrounding tissues. Sometimes, a bacterial infection may accompany it, leading to symptoms similar to those of an internal stye.
Symptoms
An external stye presents symptoms on the surface of the eyelid. Initially, it may cause slight redness, swelling, and itching, which then progresses to significant swelling and pain. After a few days, the swelling hardens, and the pain subsides as an abscess (pus-filled sac) forms, eventually discharging through the skin. However, in some cases, the infection can spread to the roots of adjacent eyelashes, resulting in multiple styes, and it may frequently recur. An internal stye is located deeper within the eyelid and can be distinguished by the appearance of a yellow abscess point on the tarsal conjunctiva.
A chalazion typically causes painless eyelid swelling that can persist for several weeks to months. If the chalazion is large, it may affect vision. A characteristic feature of a chalazion is the presence of a firm, pea-sized nodule under the eyelid skin, without redness or inflammatory symptoms such as pain. However, if the chalazion area becomes injured or infected by bacteria, it can exhibit symptoms similar to those of an internal stye.
Diagnostics
Styes and chalazia are diagnosed through medical history taking and clinical evaluation, including visual inspection and palpation. The physician examines the eyelid for lumps and signs of inflammation to make a diagnosis. If the clinical findings align with the patient’s history, no further tests are needed. However, if a chalazion recurs frequently in the same location in adults, a biopsy is recommended to rule out malignant tumors such as sebaceous gland carcinoma.
Treatment and course of the disease
A stye usually improves on its own over time, but warm compresses can provide some relief. Although warm compresses do not guarantee faster healing or reduce complications, they help alleviate inflammation and promote the discharge of the abscess. If the lesion is large or persistent, antibiotic treatment may be necessary. Applying erythromycin eye ointment to the affected area and the eyelid margin twice a day for 7–10 days can help prevent the infection from spreading to the eyelash roots, shortening the treatment duration and alleviating symptoms. If the infection spreads to the surrounding eye area or the skin around the eye, causing cellulitis, systemic antibiotic treatment is required. If the abscess does not drain or persists for a long time, the affected area may need to be incised to allow for drainage.
If a chalazion is small or does not cause significant discomfort, it can be observed without specific treatment. The fatty substance blocking the Meibomian gland can be softened with warm compresses, and gentle eyelid massage can help in its easier discharge, especially if performed early in the chalazion’s development. If a bacterial infection is suspected, antibiotic and anti-inflammatory eye drops or ointments may be used. Erythromycin eye ointment can be applied to the eyelid margin four times a day. For chronic or recurrent cases, oral doxycycline 100 mg four times a day for 14–21 days may be prescribed. If the chalazion is large, uncomfortable, or does not improve over time, treatment may involve incision and drainage to remove the contents. Occasionally, a small amount of steroid is injected into the lesion as a treatment.
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