Chalazions and styes

Disclaimer

These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Introduction

A chalazion is a small usually painless and slowly expanding lump inside the eyelid arising from a blocked Meibomian gland. The lump should appear smooth with no ulceration.

A stye (external hordeolum) is a small usually painful cyst caused by an infection at the base of an eyelash follicle.

Most chalazions and styes do not require treatment. The natural history is initial expansion followed by spontaneous rupture before healing. Topical or systemic antibiotics are not usually required.

Pre-referral investigations

History and physical examination. Chalazions and styes are not related to trauma and there should not be eye pain or abnormal eye movement.

Pre-referral management

Most chalazions and styes will resolve without treatment. Once the cyst has healed it may take up to 6 months for the inflammatory tissue ball to completely resolve.
A warm compress held against the closed eyelid for 2-5 minutes several times a day may speed up healing.
After the warm compress is applied, gentle pressure should be applied to the eyelid, using either the finger or a cotton tip to roll the eyelid towards the lid margin, i.e. upwards for the lower lid and downwards for the upper lid.
If the skin surrounding the chalazion/stye becomes cellulitic, topical or systemic antibiotics should be started with advice to seek review if no improvement within two days.

When to refer

Refer to the Ophthalmology Department:

Large lesions affecting vision.
If lesion persists for longer than three months.

How to refer

Routine non-urgent referrals from a GP or a Consultant are made via the Central Referral Service
Routine non-urgent referrals from optometrists or doctors at private hospitals are made via the PCH Referral Office
Urgent referrals (less than seven days) are made via the PCH Referral Office. Please call PCH Switch on 6456 2222 to discuss referral with the relevant speciality registrar.

Essential information to include in your referral

Approximate date of onset and any impact on vision
Any management trialed
Medical history, including if any recurrent infections, either systemic or previous chalazia.

Useful resources

What are chalazia and styes? - American Academy of Opthamology
Stye - HealthDirect

References

Arbabi EM, Kelly RJ, Carrim ZI. Chalazion. BMJ : British Medical Journal (Online). 2010;341.
Das AV, Dave TV. Demography and Clinical Features of Chalazion Among Patients Seen at a Multi-Tier Eye Care Network in India: An Electronic Medical Records Driven Big Data Analysis Report. Clinical Ophthalmology (Auckland, NZ). 2020;14:2163-8.
Boyd K. What are Chalazia and Styes [Webpage]. American Academy of Ophthalmology,; 2020. Available from: https://www.aao.org/eye-health/diseases/what-are-chalazia-styes.
HealthDirect Austalian Government Department of Health. Stye 2019 [cited 2021 03/03]. Available from: https://www.healthdirect.gov.au/stye
The Royal Children's Hospital Melbourne. Chalazion or Stye Melbourne: The Royal Children's Hospital Melbourne,; 2011 [cited 2021 04/03]. Available from: https://www.rch.org.au/kidsconnect/prereferral_guidelines/Chalazion_or_stye/.

Reviewer/Team:	Ophthalmology Department, PCH	Last reviewed:	March 2024
Endorsed by:	CPAC	Date:	March 2024

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