Stye and chalazion - Symptoms, diagnosis and treatment | BMJ Best Practice

Last reviewed:September 2019

Last updated:June 2018

Summary

Styes are typically tender to palpation, while chalazia are not.

Dacryoadenitis and dacryocystitis can be confused with stye; their respective locations (lateral upper lid and inferior to the medial epicanthus) are key.

Most styes and chalazia resolve with warm compresses and topical antibiotics.

Recurrent lesions may require biopsy to exclude carcinomas. Recurrent chalazia may require excision.

Definition

Stye, also known as hordeolum, is an acute infectious process involving abscess formation at the upper or lower eyelid. One of 3 glands is typically infected: the meibomian glands or the glands of Zeis and Moll (ciliary glands). Staphylococcus aureus (most common) and S epidermidis are typically involved, and the eyelid appears erythematous and swollen in addition to being tender to palpation.

Chalazia are non-infectious inflammatory conditions caused by a foreign body reaction to sebum released by meibomian glands.

History and exam

Key diagnostic factors

acute pain of eyelid only
pustule at eyelid margin
pustule at tarsal conjunctiva
palpable non-tender nodule
lack of constitutional symptoms
lack of eye pain
lack of intra-ocular pathology

Other diagnostic factors

chronic swelling of eyelid
age 30 to 50 years
history of blepharitis and ocular rosacea

Risk factors

age 30 to 50 years
blepharitis and ocular rosacea
seborrhoeic dermatitis
elevated serum cholesterol
diabetes mellitus

Diagnostic investigations

1st investigations to order

clinical diagnosis

Investigations to consider

biopsy
CT scan of face and orbits

Treatment algorithm

ACUTE

stye

chalazion

Contributors

AuthorsVIEW ALL 

Christopher McStay, MD

Christopher McStay

Associate Professor of Emergency Medicine

Chief of Clinical Operations

Emergency Department

University of Colorado Hospital

University of Colorado School Of Medicine

Aurora

CO

Disclosures

CM declares that he has no competing interests.

Peer reviewersVIEW ALL 

Bob Avery, MD, PhD

Assistant Professor

Ophthalmology

University of New Mexico Medical School

Albuquerque

NM

Disclosures

BA declares that he has no competing interests.

Gus Gazzard, MA, MBBChir, MD, FRCOphth

Consultant Ophthalmic Surgeon

King's College Hospital

Honorary Research Fellow

Institute of Ophthalmology

London

UK

Disclosures

GG declares that he has no competing interests.

Michael Ehrenhaus, MD

Director

Cornea, External Disease & Refractive Surgery

Long Island College Hospital Eye Center

Assistant Professor of Ophthalmology

SUNY Downstate Medical Center

Brooklyn

NY

Disclosures

ME declares that he has no competing interests.

Christopher Tedeschi, MD

Instructor in Clinical Medicine

Emergency Medicine Department

New York Presbyterian Hospital

Columbia University Medical Center

New York

NY

Disclosures

CT declares that he has no competing interests.

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