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# Chalazion and hordeolum (stye)

A stye (hordeolum) is a painful infected eyelid gland; a chalazion is a firm, usually painless lump from a blocked eyelid gland.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Eyelids](https://durgical.com/en/anatomy/superior-tarsus/)
- [Orbicularis oculi](https://durgical.com/en/anatomy/orbital-part-of-orbicularis-oculi/)
- [Cornea](https://durgical.com/en/anatomy/cornea/)
- [Tear drainage](https://durgical.com/en/anatomy/lacrimal-canaliculus/)

## In histology

- [Conjunctiva, eyelid glands and lacrimal gland](https://durgical.com/en/histology/conjunctiva-eyelid-glands-and-lacrimal-gland/)

## Why it happens

- [Granulomatous inflammation: caseating vs non-caseating, the causes to know](https://durgical.com/en/general-pathology/granulomatous-inflammation-caseating-vs-non-caseating-the-causes-to-know/)
- [Outcomes of acute inflammation: resolution, abscess, scar or chronic inflammation](https://durgical.com/en/general-pathology/outcomes-of-acute-inflammation-resolution-abscess-scar-or-chronic-inflammation/)

## What it is

Two common eyelid lumps. A hordeolum (stye) is an acute painful infection of an eyelid gland; a chalazion is a firm, usually painless, sterile granuloma from a blocked meibomian gland.

## Who gets it

Both are very common at all ages and are seen mostly in primary care. Chalazia are more frequent in adults with blepharitis or rosacea.

## Causes

- Hordeolum: bacterial infection, usually Staphylococcus aureus
- External hordeolum: gland of Zeis or Moll at the lash line
- Internal hordeolum: meibomian gland
- Chalazion: blocked meibomian gland with lipogranulomatous inflammation; may follow an internal hordeolum

## Risk factors

- Blepharitis and meibomian gland dysfunction
- Rosacea and seborrhoeic dermatitis
- Previous chalazion or hordeolum
- Poor eyelid hygiene, eye rubbing, old eye make-up
- Diabetes and immunosuppression (recurrent styes)

## Pathophysiology

In a hordeolum, bacteria infect a gland and form a small abscess with acute inflammation. In a chalazion, thick secretions block a meibomian gland; lipid leaks into the surrounding tissue and provokes a chronic granulomatous reaction, so the lump is firm and not tender.

## Classification

- Hordeolum: external or internal
- Chalazion: acute (inflamed) or chronic
- Recurrent lesions

## Symptoms and signs

- Hordeolum: red, tender, painful swelling at the lid margin, often with a yellow point
- Hordeolum: watery eye and foreign-body feeling
- Chalazion: firm, round, painless lump within the lid, slowly growing
- Large chalazion: blurred vision from pressure on the [cornea](https://durgical.com/en/anatomy/cornea/) (astigmatism)

## Red flags

- Spreading redness and swelling of the whole lid or face, fever (preseptal or orbital cellulitis)
- Proptosis, painful eye movement or reduced vision
- Recurrent chalazion in the same place, lash loss or ulceration (possible sebaceous carcinoma)
- Very large lesion in a young child (risk of amblyopia)

## Diagnosis

**Clinical**
Diagnosed on examination of the lid, including eversion. Tenderness and acute onset favour hordeolum; a firm painless nodule favours chalazion.

**Tests**
Usually none. Histopathology of recurrent or atypical lesions to exclude sebaceous gland carcinoma or basal cell carcinoma.

**Imaging**
Not needed. Orbital CT only if orbital cellulitis is suspected.

## Differential diagnosis

- Preseptal cellulitis
- Sebaceous gland carcinoma
- Basal cell carcinoma
- Molluscum contagiosum
- Xanthelasma
- Dacryocystitis (at the inner corner)

## Goal of treatment

Relieve pain and swelling, drain the blocked gland, treat underlying blepharitis to prevent recurrence, and exclude malignancy in atypical lesions.

## Treatment

**Conservative**
Warm compresses several times a day with gentle lid massage and lid hygiene; most lesions resolve in days (hordeolum) to weeks (chalazion).

**Medical**
Antibiotics are not needed for an uncomplicated hordeolum; systemic antibiotics are given if preseptal cellulitis develops. Tetracycline-class drugs for associated rosacea or meibomian gland disease.

**Procedure**
Persistent chalazion: incision and curettage through the inner lid, or intralesional corticosteroid injection.

**Procedure**
Hordeolum that points and does not drain: small incision and drainage. Squeezing is avoided.

## Complications

- Preseptal cellulitis
- Recurrence
- Astigmatism or amblyopia from a large lesion in children
- [Skin](https://durgical.com/en/anatomy/skin/) depigmentation after steroid injection
- Missed sebaceous carcinoma

## Prognosis

Excellent. Most hordeola drain within one to two weeks and many chalazia resolve with warm compresses within weeks to months; recurrences are common with untreated blepharitis.

## Prevention

- Regular eyelid hygiene and warm compresses in blepharitis
- Removing eye make-up and replacing old products
- Treating rosacea and seborrhoeic dermatitis

## Test yourself

Think of the answer, then tap the question to see it.

## What is the key clinical difference between a hordeolum and a chalazion?

A hordeolum is acute, red and painful (infection); a chalazion is a firm, usually painless granuloma from a blocked meibomian gland.

## Which organism causes most hordeola?

Staphylococcus aureus.

## Which glands are involved in an internal versus an external hordeolum?

Internal: meibomian glands. External: glands of Zeis or Moll at the lash margin.

## Which malignancy must be considered in a recurrent chalazion at the same site?

Sebaceous gland carcinoma; the lesion is biopsied.

## What is the first-line treatment for both lesions?

Warm compresses with lid massage and eyelid hygiene.

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## Related conditions

- [Conjunctivitis](https://durgical.com/en/conditions/conjunctivitis/)
- [Orbital cellulitis](https://durgical.com/en/conditions/orbital-cellulitis/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Chalazion](https://www.ncbi.nlm.nih.gov/books/NBK499889/) (StatPearls (NCBI Bookshelf), 2023); [Hordeolum (Stye)](https://www.ncbi.nlm.nih.gov/books/NBK459349/) (StatPearls (NCBI Bookshelf), 2024).

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Source: https://durgical.com/en/conditions/chalazion-and-hordeolum/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/chalazion-and-hordeolum/