Styes, Hordeola and Chalazia – a Three-Part Series. Part One.*

Today we’ll begin a three-part series covering styes and the related conditions of hordeola (pronounced ‘hor-dee-oh-la’) and chalazia (multiple correct pronunciations, including ‘sha-ley-zee-uh). These are common conditions, and there’s a lot to cover. The first post will review the textbook definition of these bumps. I’ll follow-up with a post about conservative treatments, including warm compresses and eyelid massage. The final post will cover treatments involving procedures and surgery.

Styes

Before discussing treatment options, let’s start with the textbook definition of a stye (Boyd): Styes are red, swollen, sometimes painful bumps of the eyelid arising from the oil glands of the eyelashes. Styes are often thought to arise from a bacterial infection of these glands, although this is not always the case (Boyd). As you will see below, ‘stye’ is the common term for an external hordeolum.

Internal Hordeola and External hordeola

Oil glands are common on the eyelids. The medical term for these glands is sebaceous glands. As we saw above, there are sebaceous glands associated with your eyelashes. In addition, there are sebaceous glands lining up like a picket fence along the edge of the upper and lower eyelids. In a healthy eyelid, these glands secrete oil onto the surface of the eye to keep the tear film healthy. If one of the oil glands along the edge of the eyelid becomes infected, the medical term is an internal hordeolum. An external hordeolum is the term used when a sebaceous gland associated with an eyelash becomes infected. As I mentioned previously, an external hordeolum is commonly known as a stye (Nerad). It is important to note these are ‘textbook’ definitions, because the role infection plays is not agreed upon by all doctors (Nerad). This is not surprising, because antibiotics don’t offer much help in most cases of hordeola and styes (BCSC),* but it is still important to check with your doctor to confirm you don’t need antibiotics if you think you have one of these conditions. One thing almost all doctors do agree on is that styes are diseases of the oil glands of the eyelids, regardless of exactly what role infection plays.

Chalazia

There is another type of oil gland disease called a chalazion (the plural is ‘chalazia.’) We generally call an eyelid oil gland cyst a chalazion if the oil gland cyst has not resolved after one month; oil gland cysts of shorter duration typically qualify as hordeola. Like hordeola, chalazia are swollen eyelid bumps that represent a problem with the sebaceous glands of the eyelids, but unlike hordeola, most doctors do not feel chalazia represent a bacterial infection. Rather, textbooks define chalazia as swollen eyelid bumps that results when a sebaceous gland of the eyelid plugs. When the gland plugs, the oil can’t escape the eyelid, so it builds up forming a swollen knot. We don’t fully understand what causes these glands to block, although there are number or theories. We do know the skin condition rosacea is a risk, as is the eyelid condition of blepharitis (Cetinkaya, Liang). Another theory is that a common skin mite, Demodex brevis, may be a risk for chalazia (Liang). While we are always learning more, our understanding of exactly what causes chalazia remains incomplete.

By now I hope you see both hordeola and chalazia represent swollen eyelid bumps caused by problems with the sebaceous glands of the eyelids. Given the similarities, you can imagine it is often difficult to distinguish these two types of eyelid bumps. In the real world, whether to call an eyelid bump a chalazion or a hordeolum isn’t universally agreed upon by all doctors (Nerad). Moreover, determining whether the bump is a chalazion or a hordeoulum oftenisn’t very useful, because doctors treat hordeola and chalazia very similarly. I will dive into treatment in the next post, but the take home message is hordeola and chalazia are very similar eyelid bumps caused by diseased oil glands of the eyelids.

References:

Boyd K. What Are Chalazia and Styes? Editor Pagan-Duran MD B. American Academy of Ophthalmology. https://www.aao.org/eye-health/diseases/what-are-chalazia-styes. September 1, 2017. Accessed February 8, 2019.

Nerad, Jeffrey. Techniques in Ophthalmic Plastic Surgery. Elsevier, 2010.

Basic and clinical Science Course (BCSC): External Disease and Cornea, Section 8. American Academy of Ophthalmology, 2010.

Liang L, Ding X, Tseng SC. High prevalence of demodex brevis infestation in chalazia.

Am J Ophthalmol. 2014 Feb;157(2):342-348.e1. doi: 10.1016/j.ajo.2013.09.031. Epub 2013 Oct 2.

Cetinkaya A, Akova YA. Pediatric ocular acne rosacea: long-term treatment with systemic antibiotics. Am J Ophthalmol. 2006 Nov;142(5):816-21.

*As always, any information on this website is informational and does not replace the need to see an eye care professional