Signs and Symptoms
Chalazion: Patients will present with one or many focal, hard, painless nodules in the upper or lower eyelid. They may report some enlargement over time, and there may be a history of a painful lid infection prior to the chalazion development, but this isn't always the case. Chalazia are often recurrent, especially in cases of poor lid hygiene or concurrent blepharitis.
Hordeolum: A common staphyloccal infection of the lid glands; essentially an abscess, with pus formation; symptoms include swelling, redness, and pain. Two types are classified: internal hordeolum (relatively large, affecting the meibomian glands; may point toward the skin or toward the conjunctive) and external hordeolum (also known as a "sty;" smaller and more superficial; an infection of the glands of Moll or Zeiss; painful; always points toward the skin side of the lid margin). An external hordeolum arises from a blockage and infection of Zeiss or Moll sebaceous glands. An internal hordeolum is a secondary infection of meibomian glands in the tarsal plate. Both types can arise as a secondary complication of blepharitis.
Management
Chalazion: Because chalazia reside deep under the skin, no topical medications will be able to penetrate sufficiently. About 25 percent of chalazia resolve spontaneously. For those that don't, instruct the patient to apply a hot compress to open the glands, then to digitally massage the area to break and express the nodule, up to four times a day. If this is ineffective, inject triamcinolone acetonide (Kenalog) directly into the chalazion Intralesional steroid injection is contraindicated for patients with dark skin, since the procedure can cause depigmentation which often persists for months, or is permanent. This is especially likely if the point of injection is on the skin, but may occur even if injecting through the palpebral conjunctiva. Usually the patient is markedly better one week later, but you may need to re-treat extremely large chalazia. If the chalazia persist even after a second steroid injection, or if the patient cannot tolerate the procedure, excise the remaining lesion using a curette under local anesthesia as a last resort. Biopsy any recurrent chalazia, especially those following surgical excision, to rule out a particularly deadly malignancy known as sebaceous gland carcinoma.
Hordeolum: Warm compress, digital massage of the eyelid margin, and topical antibiotic ointment are the first line of treatment. Incision and curettage are necessary if there was no response to the previous management.