Both chalazia and stys appear as lumps in, or along, the edge of the eyelid and can be difficult to distinguish between; however, they are fundamentally different.
Chalazia (Meibomian Cysts)
A chalazion, also known as a meibomian gland lipogranuloma, is a cyst in the eyelid that forms when the oil-producing meibomian gland in the eyelid becomes enlarged and the gland opening becomes clogged with oil. Inflammaton of the gland results in meibomianitis.
Meibomian cysts are one of the most common reasons for referral. Most resolve spontaneously, hence, incision & curettage is reserved for very persistent, unsightly or astigmatism causing meibomian cysts. The remaining patients are given appropriate treatment and reassured that the meibomian cyst is very likely to resolve spontaneously.
Symptoms and signs include:
- swelling on the eyelid
- eyelid tenderness
- sensitivity to light
- increased tearing
- heaviness of the eyelid
- possible acute inflammation
Unlike a stye, a chalazion is not an infection and is usually a painless nodule that points inside the lid, rather than on the lid edge.
Acute cysts of whatever size are usually best managed conservatively so that the meibomian cyst reduces in size and becomes less inflamed. This is best done using lid hygiene with baby shampoo, hot compresses (ideally with an eye bag), ocular lubricants for tear film instability, topical steroids for inflammation or Doxycycline 100 mg once daily for severe meibomianitis or associated facial rosacea. Patients with recurrent meibomian cysts are best managed conservatively to try reduce the number of tarsal incisions which may cause future ocular discomfort.
Acute and chronic cysts are managed by the patient. They are informed of:
- Lid hygiene using baby shampoo, initially every night just before sleeping for a period of 3 months.
- Hot compresses help to liquefy the contents of a cyst and aid ocular comfort by increasing surfactant release from the meibomian glands into the tear film. The best tool is an eye bag – this is a wheat bag specially designed for the eyes and is available from www.theeyebagcompany.co.uk for £20 including postage.
- In the presence of severe meibomianitis / recurrent and multiple meibomian cysts / facial rosacea, the patient is asked to take Doxycycline 100 mg daily for 3 months.
- Ocular lubricants for comfort. These are used to stabilise the tear film which otherwise breaks up rapidly due to meibomian gland disease.
A stye, also known as a hordeolum, often appears as a red, sore lump near the edge of the eyelid and is caused by an infected oil gland/follicle at the base of the eyelash. The infection commonly occurs in the sebaceous glands of Zeiss at the base of the eyelashes, or in the apocrine sweat glands of Moll.
An early symptom of a stye is a small, yellowish spot at the centre of the lump that develops as pus and fills and expands in the area. Other signs and symptoms include:
- A lump on the top or bottom eyelid
- Swelling of the eyelid
- Pain or tenderness
- Mucous discharge and crusting at the eyelid edges
- Droopy eyelid
- Blurred and/or light sensitive vision
- Discomfort during blinking
- Irritation of the eye (burning, scratchy/itching, sensation of a foreign body in the eye)
Treatment for chalazia and styes
There are a number of treatments for chalazia and styes, depending on the severity of the problem and the patient's susceptibility to the condition.
The simplest treatment to aid the healing process is to hold a warm compress (a cloth warmed with warm water) against the eye for 10 to 15 minutes, 3 to 4 times a day. The compress helps clean the glands, release the clogging and in the case of styes, drain the pus and allow a quicker healing process. If an internal stye does not drain naturally and heal, it can turn into a chalazion.
Simple chalazia and styes often require no antibiotic treatment. However, should the area become infected, an antibiotic ointment may be prescribed for bacterial infections. Antibiotic ointments are also prescribed if the patient is particularly susceptible to the condition and the problem frequently reoccurs.
A steroid (cortisone) injection is sometimes used to reduce swelling of a chalazion. Steroid therapy is most often used is the case of common non-infected chalazion, being most successful if secondary infection has not occurred. Steroid injections are particularly effective and frequently used on children, or people who suffer allergic reactions to local anaesthetics.
If a large chalazion or stye affects vision, does not heal after conservative treatment, or has become secondarily infected, surgery may be needed to drain it. This surgery is a safe and simple procedure, conducted under local anaesthetic and can be followed by a short course of antibiotics.
Follow-up procedures are rarely necessary and after the surgery, eyelid swelling and bruising should disappear in around 1-2 weeks.
If you have been affected by any of the symptoms mentioned above, please don't hesitate to give us a call.
We have a team of experts on stand-by who are ready to take your call at our Manchester (0161 907 2685) Clinic or our Blackpool (01253 308 031) Clinic.