“I think he’s got a stye” is a common presenting complaint to primary care, urgent care or even ED. It seems surprising how many clinicians get muddled between styes and chalazions and, even more, how we aren’t always sure how to treat them (hint: often, they don’t need treating, just simple reassurance).
Both styes and chalazions will present with a lump in the eyelid.
Chalazions/Meibomian Cysts
The eyelid contains numerous small glands called Meibomian glands, which produce the oily tear film that keeps the eyes well-lubricated. One of these glands can get blocked by the oily fluid solidifying, resulting in a lump inside the lid called a chalazion. These can affect the upper or lower lids, though more commonly the upper.
Stye/external hordeoleum
A stye is a blocked gland on the edge of the eyelid that presents as a small boil or abscess. The term is also used for a boil/abscess from an eyelash follicle. Styes are more common in people who have rosacea or blepharitis.
Treatment
The treatment for chalazions and styes is largely self-care and non-invasive. The NHS website advises
- Soak a clean flannel in warm water.
- Hold it against your eye for 5 to 10 minutes.
- Repeat this 3 or 4 times a day.
Moorfields Eye Hospital has an excellent leaflet for parents and carers of children with chalazions.
Occasionally, chalazions (and less often, styes) can become infected, with spreading cellulitis around the area, which will need treatment with antibiotics.
Surgery is rarely indicated and has been designated a Procedure of Limited Clinical Value (PLCV) in most areas of the UK. This means special dispensation is required to operate, usually if the chalazion is so large that it is interfering with vision. Incision and drainage are unusual, though they may be considered with a large, tense/pointing abscess. Some doctors will consider removing an adjacent eyelash if it seems likely to drain a stye, though this is often not possible in a young and wriggly child. Lid hygiene is recommended if children get recurrent styes or chalazions due to blepharitis. There’s a good step-by-step video below.
