Styes (hordeola) are typically tender to palpation, while chalazia are not.
Dacryoadenitis (infection or inflammation of the lacrimal gland) and dacryocystitis (infection of the lacrimal sac) 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.
A stye, also known as a hordeolum, is caused by an acute infectious process involving localised 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
- age 30 to 50 years
- blepharitis and ocular rosacea
- seborrhoeic dermatitis
- elevated serum cholesterol
- diabetes mellitus
1st investigations to order
- clinical diagnosis
Investigations to consider
- CT scan of face and orbits
Christopher McStay, MD
Associate Professor of Emergency Medicine
Chief of Clinical Operations
University of Colorado Hospital
University of Colorado School Of Medicine
CM declares that he has no competing interests.
Bob Avery, MD, PhD
University of New Mexico Medical School
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
GG declares that he has no competing interests.
Michael Ehrenhaus, MD
Cornea, External Disease & Refractive Surgery
Long Island College Hospital Eye Center
Assistant Professor of Ophthalmology
SUNY Downstate Medical Center
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
CT declares that he has no competing interests.
- Chalazion (Meibomian cyst)
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