Chalazion and hordeolum: all about sty and chalazion

Author: Dr. Victor Derhartunian 7 February 2024

Regardless of age and gender, people are affected by diseases such as sty and chalazion.
In most cases, these are not dangerous and disappear by themselves after a while – but sometimes they do not.
Here you can find out the difference between chalazion and hordeolum, what they actually are, what the causes and symptoms are and which treatment options really help.

What are chalazion and hordeolum?

The “common diseases” chalazion and hordeolum are the most widespread problems of the eyelid.
In everyday language, we speak of chalazion and hordeolum.
But what are they actually?

A chalazion is a benign, usually painless lump or swelling that occurs due to a blockage of the meibomian glands.
The meibomian glands are actually responsible for enriching the tear film with a secretion of lipids or fats.
However, if the fluid cannot escape, it collects in the glands and causes swelling and inflammation.

Hailstone on the patient's eye

A stye, on the other hand, is a painful and swollen bump that forms on the eyelid when a bacterial infection caused by Staphylococcus aureus bacteria occurs.
A distinction is made between

  1. External sty in the region of the eyelashes
  2. Internal sty on the inside of the eyelid

Symptoms of sty and chalazion at a glance

Some of the symptoms of chalazion and hordeolum are similar.
However, the eye diseases differ in key aspects.
In addition, the symptoms vary depending on the severity and individual perception.
Clear indications of the presence of an eyelid disease can be:

Barley grain (Hordeolum) Hailstone (Chalazion)
Pain in the eyelid Swelling of the eyelid
Redness and swelling Hard lump or bump
suppuration Redness
Itching Painlessness
Enlarged eyelashes follicles or sebaceous glands Feeling of pressure due to swelling
Impaired vision Limited vision

Probably the most serious and clearest difference between chalazion and sty is that one is painful and the other is painless.

Causes of these eye diseases:

A sty is the result of a bacterial infection.
When the bacteria penetrate the sebaceous glands or hair follicles of the eyelashes and cause an infection, the sty develops.
Risk factors and causes for such an infection are

  • Lack of eyelid hygiene
  • Frequent rubbing of the eyes
  • Increased risk due to skin diseases such as rosacea
  • Weakened immune system
  • Blocked sebaceous glands

Transmission through direct contact with other people is extremely rare.

In contrast, the chalazion is not due to an infection.
It is caused by blockage of the meibomian glands located in the eyelid.
Why these glands are blocked varies from case to case:

  • External influences such as dust, dirt, make-up obstruct the drain
  • Previous conjunctivitis or inflammation at the edge of the eyelid
  • Excessive sebum production increases the likelihood of
  • Hormonal changes (e.g. puberty)

What to do with chalazion and sty

In most cases, the chalazion or sty will disappear by itself after a while.
However, you should keep a close eye on its development.
If the symptoms become increasingly severe, if it does not improve over a longer period of time (chronic) or if it recurs at regular intervals, it is advisable to consult a doctor you trust.

Diagnosis of chalazion and hordeolum

Don’t worry about a possible visit to the doctor.
The diagnosis and differentiation of chalazion and hordeolum is painless for you and is possible without invasive procedures:

  1. Medical history
  2. Examination of the affected eye
  3. Differentiation between chalazion and sty
  4. Light microscopic examination / slit lamp

The diagnosis is then usually made and the cause of the eyelid problems identified.
Only in exceptional cases is an additional laboratory examination necessary.

Treatment options for eyelid problems

If the sty does not go away on its own, you should never try to express it yourself.
In the worst case, this will only intensify the problem.
Hordeolum is usually treated by:

  • Warm compresses to open the sebaceous glands and promote drainage
  • In the case of a severe infection, administer antibiotics
  • Opening the sty to drain the pus
  • Ointments or drops with antibiotic active ingredients
  • Gentle massage of the eyelid

If the infection is so bad or if an abscess (pustule) has already formed, surgical removal may be necessary in rare cases.

Warm compresses and eyelid massages can also help with chalazion.
Over-the-counter eye drops are used to treat dry eyes.
In persistent cases, you will be given a corticosteroid injection or the chalazion will be opened by a doctor.

Tips for preventive measures

There is no complete guarantee that you will not develop a chalazion or stye.
However, even small everyday tips can greatly reduce the risk – especially for people who are prone to eyelid problems:

  • Regular cleaning of the eyelids (removal of dirt, bacteria and oil)
  • Reduce contact between hand or fingers and eyes
  • As a contact lens wearer, follow the cleaning and care instructions
  • Daily make-up removal before going to bed
  • Warm compresses if required
  • A balanced diet and healthy lifestyle strengthens the immune system
  • Regular visits to the ophthalmologist for early detection and rapid treatment
  • Separate towels and hygiene products (e.g. cotton pads)
author image

Author:

Dr. Victor Derhartunian

Nachdem er sein Handwerk von den beiden Pionieren der Laserchirurgie gelernt hat, gehört Dr. Victor Derhartunian zu den führenden Augenlaser-Chirurgen. Er leitet die Praxis in Wien und kann seine Patienten in fünf Sprachen beraten.