Chalazion and Hordeolum (Stye)

Each eyelash has its own oil gland. There are also about 25 specialized (Meibomian) oil glands within each eyelid. The oil from these glands is essential for a properly functioning tear film. Sometimes, however, the oil becomes “too thick,” the gland gets clogged, and oil leaks into the eyelid.

Even though this oil is sterile, our immune system treats it as a foreign substance. This is not an infection; it is a sterile reaction to material (oil) that doesn’t belong under the skin.

When the gland attached to an eyelash gets backed up, this is a hordeolum (stye). Hordeola are typically red, swollen and tender. They can become secondarily infected with bacteria. When a Meibomian gland becomes clogged, the result is a chalazion. Chalazia tend to get rather large but are usually painless. Both hordeola and chalazia are essentially a “pimple” in the lid.

Conservative Approach

Antibiotics usually play no role in treating stye or chalazion are these are sterile inflammations. The best initial treatment is a frequently applied hot compresses. Hot compresses liquefy the oil and may allow the pore to open and the oil to come out. With styes, we sometimes prescribe a steroid drop to reduce inflammation. However, if the stye has evidence of secondary bacterial infection, then a steroid/antibiotic drop will be prescribed.

One way to create a hot compress is to heat a potato and wrap a damp towel around it. You can also use the hot/cold packs or beads that are sold in pharmacies. These stay hot for a long time, whereas a hot towel does not. Our general recommendation is to apply hot compresses 3-4 times a day for 5 minutes for a week or two. Don’t be surprised if the eyelid skin becomes dry from frequent compresses. If this happens, a thin layer of Vaseline twice daily will help. Sometimes the skin opens and
the lesion drains; this will heal well.

Intervention

Even if hot compresses don’t help much, these lesions often resolve on their own over time (months to years). There is no danger to the eye or vision, so leaving it alone is a perfectly reasonable option.

However, if the chalazion is causing distress to you or your child there are other options. For emotionally mature children (usually older than 9 years) who have had a chalazion or hordeolum for less than 2 months, we can inject steroid directly into the eyelid in the office. Steroid injection is safe and usually effective, but there is no guarantee it will work (or work totally). The greatest risk of this (though unlikely to occur) is depigmentation (a white spot) in the skin from the medication. While this doesn’t happen often, there are rare instances of permanent discoloration. This is more of a problem for darker-skinned people, as the contrast is greater. We can also drain these lesions surgically. Surgery for younger children (and many teens) involves a visit to the operating room and general anesthesia for a few minutes. While the child is asleep, we make a small in the lid and drain the oil and inflammatory debris. Whenever possible, the incision is made on the undersurface of the lid. Sometimes, the eyelid skin is thinned out from the

lesion and disintegrates during surgery; this usually heals well on its own but sometimes a stitch is needed. There are usually no complications but every surgery has potential risks. The risks of this surgery are infection, recurrence of the chalazion (or stye), leaving behind some of the chalazion wall, and minor bleeding. There is also the risk of the steroid leaving a small white mark (as with the office option). The likelihood of vision loss is near zero, but any surgery on or near the eye carries this risk.

Prevention

Dietary supplements containing omega 3 fatty acids (found in flax seed oil and cold-water fish) change the way our body makes these oils, allowing the oils to flow better. Omega-3 supplments are not a miracle cure, and don’t always work for everyone, but most patients do benefit and some benefit a lot. We recommend trying 3-4 months of 1 daily tablespoon (15 ml) of Barlean’s Seriously Delicious Flaxseed Oil (either BlackBerry or Strawberry Banana). This is available online, directly at Barleans.com and other sites including Amazon.

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Ensure Your Child’s Comfort and Eye Health

If your child shows signs of a chalazion, don’t wait to seek treatment. Contact us today to schedule a consultation and learn about effective treatment options to restore your child’s eye health and comfort.

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