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Chalazion & Styes

Checked: 23-01-2020 by Vicky Ryan Next Review: 23-01-2021

Overview

Chalazion

These are blocked glands on the eyelids which, once blocked, form a lipogranulomatous reaction and become swollen. They are typically painless and can be accompanied by others chalazia on the eyelids. Chalazia are caused by dysfunction of the glands similar to that seen in blepharitis so early treatment should be directed as in the blepharitis section of this advice.

Chalazion can become infected and may require antibiotics both topically and orally.

Styes

Styes, or hordeolum, are when blocked glands on the eyelids become secondarily infected and require antibiotics. There is often a pointed head on the cyst (which may be internal or external) and it may fistulate and discharge pus through the skin.

See diagnostic photograph.

Who to refer

If particularly problematic, the BNSSG CCG will allow referral to BEH for consideration of surgical removal only with ‘prior approval’ via ‘individual funding request.’ This is based on the following:

The CCG will fund excision of chalazia when the patient presents with two or more of the following:

Present continuously for more than six months, verified in clinical notes
Present on the upper eyelid, and interferes significantly with vision.
Source of regular infection (2 times within six-month time frame) requiring medical treatment
The site of the lesion or lashes renders the condition as requiring specialist intervention within the secondary care provider.

A chalazion that keeps coming back should be biopsied to rule out malignancy. Use the appropriate referral route for suspected malignancy in this case. Note: The chalazion does not need to be present continuously for more than six months.

See link to the Chalazia Removal BNSSG policy for details.

Styes

Please refer urgently if signs of preseptal cellulitis.

Red Flags

Chalazion & Styes - Spreading cellulitis should prompt urgent referral to the BEH Emergency Department.

Before referral

Chalazion

Chalazia are caused by dysfunction of the glands similar to that seen in blepharitis so early treatment should be directed as in the blepharitis section of this advice. This can include:

Warm compress and lid massage
Chloramphenicol ointment BD for 2 weeks
Oral tetracycline to treat any coexistent meibomian gland dysfunction.

Styes

Styes will often require some form of antibiotic. If the infection is limited to the cyst and there is no spreading cellulitis infection, this can be managed with topical antibiotic ointment (usually chloramphenicol ointment 2-3xday for 7-14 days) with hot compress and lid massage to encourage the gland to discharge. If a stye does start to discharge through a fistula, it should be encouraged with a hygienic massage.

If there is spreading cellulitis from the cyst which is affecting the rest of the eyelid, it is best to treat this as early cellulitis and treat with oral antibiotics (See Cellulitis Section). If you are concerned at the level of infection, please discuss with the on-call ophthalmologist for review.

Once the infection has been treated, the blocked cyst may remain for several months and hot compress and massage should be continued to speed resolution. It is advisable to treat coexistent blepharitis.

Referral

If referral is required (and prior approval has been obtained) please submit to Ophthalmology via eRS requesting Oculoplastics

Resources

These guidelines have been written by Rhys Harrison, consultant ophthalmologist at Bristol Eye Hospital, with thanks to the patients who have kindly given consent to use their photos.

For full ophthalmology guidelines see: Primary Care Ophthalmology Guidance Document

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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