Diagnosis of Styes (Chalazia/Hordeolum)

A chalazion, also known as a meibomian gland lipogranuloma, is a cyst in the eyelid that is caused by inflammation of a blocked sweat gland or meibomian gland, on the lid.  It is so common that most Ophthalmologists see a few patients a day who present with these chalazia.  They are more common in the summer, when people sweat more but they can present in any season.  They form with the oil produced in the glands becomes thickened and is unable to flow out of the gland.  The oil builds up inside the gland and forms a lump in the eyelid.  The gland may break open and release the oil into the surrounding tissue, causing inflammation of the eyelid.  Chalazia can become super-infected with bacteria if bacteria contaminate the broken skin formed by chalazia.  A hordeolum or stye is formed, similarly in the Meibomian glands of the eyelid.  Hordeolum, however, are more painful and tend to cause injection and irritation of the lid and adjacent conjunctiva.  They are caused by a Staphylococcal infection of the eyelid.

Chalazia usually form in patient who have blepharitis.  Blepharitis is an inflammation of the eyelid, associated with Rosacea, infection and dry eye.  Demodex, is a mite that has recently been found to be a contaminant in patients with Blepharitis and Chalazia.  It is extremely difficult to eradicate and is more common in elderly patients then in children. Hordeolum and Chalazion are both treated with warm compresses (without burning the skin) and lid scrubs.  There are many available lid scrubs on the market including Ocusoft lid scrubs and Systane lid scrubs.  Patients can additionally use baby shampoo to cleanse the lids as it is not irritating to the cornea.  If a chalazia/hordeolum starts to cause a preseptal cellulitis or infection of the adjacent tissue, oral antibiotics may be used as treatment.  If the cellulitis becomes severe, IV antibiotics may become necessary.  Many Ophthalmologists prescribe a combination antibiotic/steroid drop or ointment such as Tobradex to treat the inflammation formed by these lesions.  If the chalazion is resistant to treatment or in children, if it starts to cause an astigmatism of the eye, surgical treatment is often necessary.   Chalazia are relatively easy to remove by an experienced Ophthalmologist.  The removal in adults is done under a local anesthetic.  Since young children often have difficulty sitting still, they sometimes need general anesthesia for surgical removal.  Demodex can be similarly treated with warm compresses, lid scrubs and Tobradex ointment.  50% tea tree oil or tea tree shampoo has been tried as a treatment as well.  Tea tree oil, however, can be very irritating to the eye and should be used with caution. While uncomfortable and annoying, Chalazion are usually not dangerous.  They can persist for months and wax and wane.  In rare circumstances, they can be associated with a cancer known as sebaceous cell carcinoma so if these chalazions do persist, an Ophthalmologist should evaluate for treatment and possible biopsy.

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