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Chalazia and
hordeola are sudden-onset localized swellings of the eyelid. A chalazion
is caused by noninfectious meibomian gland occlusion, whereas a
hordeolum is caused by infection. Both conditions initially cause
eyelid hyperemia and edema, swelling, and pain. With time, a chalazion
becomes a small nontender nodule in the eyelid center, whereas a hordeolum
remains painful and localizes to an eyelid margin. Diagnosis is
clinical. Treatment is with hot compresses. Both conditions improve
spontaneously, but incision or, for chalazia, intralesional corticosteroids
may be used to hasten resolution.
Chalazion:
A chalazion is noninfectious obstruction of a meibomian gland causing extravasation of irritating lipid material in the eyelid soft tissues with focal secondary granulomatous inflammation. Disorders that cause abnormally thick meibomian gland secretions (eg, meibomian gland dysfunction, acne rosacea) increase the risk of meibomian gland obstruction.
Hordeolum:
A hordeolum, or stye, is an acute, localized, pyogenic (usually staphylococcal) infection or abscess of the eyelid that may be external or internal. Most hordeola are external and result from obstruction and infection of an eyelash follicle and adjacent glands of Zeis or Moll's glands. Follicle obstruction may be associated with blepharitis. An internal hordeolum, which is very rare, results from infection of a meibomian gland. Sometimes cellulitis accompanies hordeola.
Symptoms
Chalazia and hordeola both cause eyelid redness, swelling, and pain.
Chalazion:
After 1 or 2 days, a chalazion localizes to the body of the eyelid. Typically, a small nontender nodule or lump develops. A chalazion usually drains through the inner surface of the eyelid or is absorbed spontaneously over 2 to 8 wk; rarely, it persists longer. Vision may be slightly blurred.
Hordeolum:
After 1 to 2 days, an external hordeolum localizes to the eyelid margin. There may be tearing, photophobia, and a foreign body sensation. Typically, a small yellowish pustule develops at the base of an eyelash, surrounded by hyperemia, induration, and diffuse edema. Within 2 to 4 days, the lesion ruptures and discharges pus, thereby relieving pain and resolving the lesion.
Symptoms of an internal hordeolum are the same as those of a chalazion, with pain, redness, and edema localized to the posterior tarsal conjunctival surface. Inflammation may be severe, sometimes with fever or chills. Inspection of the tarsal conjunctivae shows a small elevation or yellow area at the site of the affected gland. Later, an abscess forms. Spontaneous rupture is rare; however, when it does occur, it usually occurs on the conjunctival side of the eyelid and sometimes erupts through the skin side. Recurrence is common.
Diagnosis
Diagnosis of chalazion and both kinds of hordeola is clinical; however, during the first 2 days, they may be clinically indistinguishable. Because internal hordeola are so rare, they are not usually suspected unless inflammation is severe or fever or chills are present. If the chalazion or hordeolum lies near the inner canthus of the lower eyelid, it must be differentiated from dacryocystitis (see Eyelid and Lacrimal Disorders: Dacryocystitis), the diagnosis of which can usually be excluded by noting the location of maximum induration and tenderness (eg, eyelid for a chalazion and under the medial canthus near the side of the nose for dacryocystitis). Chronic chalazia that do not respond to treatment require biopsy to exclude tumor of the eyelid.
Treatment
Hot compresses for 5 to 10 min 2 or 3 times a day can be used to hasten resolution of chalazia and external hordeola.
Chalazion:
Incision and curettage or intrachalazion corticosteroid therapy (0.05 to 0.2 mL triamcinolone 25 mg/mL) may be indicated if chalazia are large, unsightly, and persist for more than several weeks despite conservative therapy.
Hordeolum:
An external hordeolum that does not respond to hot compresses can be incised with a sharp, fine-tipped blade. Systemic antibiotics (eg, dicloxacillin or erythromycin 250 mg po qid) are indicated when cellulitis accompanies a hordeolum.
Treatment of internal hordeola is oral antibiotics and incision and drainage if needed. Topical antibiotics are usually ineffective.
Last full review/revision November 2007 by James Garrity, MD
Content last modified November 2007
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