Printer Friendly FormatSTYE VERSUS CHALAZION
(hordeolum caused by a bacterial infection) and a chalazion (lipogranuloma from inflammation).
Anatomy. The eyelid can be divided into the lid margin which includes the eyelashes and the remainder of the eyelid. The lid margin is the area where the openings of several glandular ducts are found. The glands of Zeis and Moll are found near the eyelashes. When they are infected with bacteria, a stye develops.
The structural support of the eyelid is the tarsal plate, which is a flat, fibrous structure that contains the meibomian glands. These meibomian glands produce an oily material which exits from the small duct openings which are located along the eyelid margin near the eyelashes. The oily material helps to decrease tear evaporation and by surface tension, helps to spread the tears more evenly over the surface of the cornea.
Pathophysiology. If the meibomian gland or duct becomes obstructed, the oily material creates an inflammatory reaction in the surrounding tissue. If this persists, the reaction will stimulate the formation of fibrous tissue around the inflammation. The initial obstruction of the gland or its duct may be unexplainable. There are, however, some predisposing factors for formation of the chalazion. These are bacterial infection, rubbing of the eyes, long-term infection of the eyelid margin with crusting and redness(blepharitis), or altered, thickened glandular secretions.
Initially, the involved area of the chalazion can be swollen and red. This either will resolve or form a lump in the eyelid between the eyelash area and the fold of the eyelid. If the chalazion is small, it may resolve and disappear. Others will become quiet, or stable, and remain as a smooth painless lump. On rare occasions, they will become larger and erupt through the skin of the eyelid or protrude from the inner surface of the eyelid. The latter type can cause a smooth, 2 to 4 millimeter pink-red mass of tissue which resembles a small mushroom or pancake on the underside of the lid.
An infectious stye may occur as a red, slightly tender, raised area on the anterior lid surface. This pustular area can enlarge and involve the entire eye lid and produce eyelid edema, ecchymosis or even cellulitis.
TREATMENT FOR STYE (HORDEOLUM)
Since a stye is an infection, it will usually respond to warm compresses and topical or systemic antibiotics. Cultures are difficult to obtain unless an actual pustule occurs. Most organisms will be gram positive unless the child's immune system is compromised.
TREATMENT FOR A CHALAZION
Medical. Initial treatment consists of moist heat applied to the eyelid, 2 to 4 times a day. This is best achieved by resting a moist wash cloth against the closed eyelid. Depending upon the suspected ratio of infection to inflammation, an antibacterial ointment or antibacterial/steroid ointment may also be applied to the eyelid. In select patients with fair pigmentation, a steroid injection into the chalazion may produce resolution. 
Surgical. If the chalazion does not respond in a few weeks to a month, excision of the chalazion is usually suggested. In young children and adolescents surgery is done in the operating room with the help of a brief anesthetic. This permits excision without the risk of injury due to an uncooperative child. Surgery is typically performed as an outpatient and patients are discharged shortly after full recovery from the anesthesia.
Technique. Whether the chalazion is presenting externally through the eyelid skin or internally from the inner surface of the eyelid, the contents of the chalazion and the surrounding fibrous sack are excised. This involves a cut in the eyelid either internally or in rare cases externally. When an external approach is used, the horizontal skin incision is closed with absorbable sutures. There is usually minimal or no scarring of the skin. When excised internally, the contents are removed through a vertical incision and sutures are not necessary. After the surgery is completed, an antibiotic ointment is placed on the eyelid skin or under the eyelids. A soft eye patch may be used for a few hours after surgery.
Post-Operative Care and Follow-Up. Ophthalmic ointment is used for the next 5 days. The child should refrain from swimming for one week. Other than this, there are no restrictions in activity. After 7 to 10 days, the patient's progress is checked. A chalazion will not return if the gland is removed. However, other glands may become involved in other areas in susceptible individuals.
Pediatric Ophthalmology and Strabismus, Inc.
