Author: Claude (AI), from PubMed abstracts · Reviewed by: Dr Mina Abdelmseih · Reviewed: 2026-11-15 · Review due: 2027-11-15

Educational content only. Not personalised medical advice. Clinical decisions remain the responsibility of the treating clinician.

Chalazion and Hordeolum

A hordeolum is a common, painful, usually bacterial inflammation of the eyelid oil glands; internal hordeola involve the meibomian glands and external hordeola (styes) the glands of Zeis or Moll [S6] [S7]. A chalazion is a common eyelid mass caused by chronic inflammation of the sebaceous glands [S12]. Both are usually benign, but a lid nodule treated as a chalazion can hide a malignant tumour [S10].

Key points - Many hordeola drain spontaneously, often in about a week; recurrences are common [S6] [S7]. - No trials support or refute non-surgical treatments for acute internal hordeolum [S6]. - For chalazion, warm compresses and lid hygiene are first line, but complete resolution with conservative treatment alone was 18% in one RCT [S8] [S12]. - Incision and curettage (I&C) is more effective than steroid injection after one procedure, with the gap narrowing after one or two attempts [S5].

Evidence last checked: 2026-10-17 (PubMed abstracts).

Red flags

• Recurrent or atypical "chalazion": a nodular lid thickening treated as chalazion can be a malignant neoplasm [S10].
• Spreading redness and swelling: an unresolved internal hordeolum can progress to generalised eyelid cellulitis [S7]; see the orbital and preseptal cellulitis article.
• Steroid injection in pigmented skin: skin depigmentation is relatively common [S1].

Recognise it

• Hordeolum: acute, painful, purulent inflammation of the lid margin [S7]. It is infectious, whereas a chalazion is not [S10].
• Chalazion: a lid mass from retained meibomian or Zeis gland secretion, seen in all age groups [S11] [S12]. An unresolved internal hordeolum can become chronic or develop into a chalazion [S6].
• Children: consider underlying vitamin A deficiency, Demodex infestation or rosacea [S12].

Confirm it

• Diagnosis is clinical [S10].
• Send tissue for histology when the lesion is recurrent or atypical, because a malignant tumour can masquerade as a chalazion [S10]. Steroid injection is suited to cases where the diagnosis is straightforward and no biopsy is required [S4].

Manage it

Before acting on this section, check the national and local guidelines, product information and regulatory approvals that apply where you practise. See the medical disclaimer.

Tier A (primary care / no specialist)

• Hordeolum: expect spontaneous drainage in many cases [S6]. Warm compresses, lid scrubs, antibiotics and steroids are used but are unproven by trials [S6]. Acupuncture trials from China gave low to very low certainty evidence of short-term benefit [S7].
• Chalazion: warm compresses and lid hygiene first [S12]. In a 149-patient RCT, adding tobramycin or tobramycin/dexamethasone to hot compresses did not improve resolution (21%, 16% and 18% complete resolution; no significant difference) [S8].
• Refer lesions that persist beyond about 2 months: older lesions were less likely to resolve conservatively [S8].

Tier B (general eye clinic)

Intralesional triamcinolone (steroid injection) - In an RCT of 94 patients after failed conservative treatment, 4 mg triamcinolone gave 81% complete resolution vs 79% with I&C, as reported in [S4]; average time to resolution was 5 days [S4]. - A three-arm RCT (136 patients) found 0.2 mL of 10 mg/mL triamcinolone almost as effective as I&C (84% vs 87%) with less pain and inconvenience; hot compresses alone resolved 46%, as reported in [S3]. - An RCT from Nepal (118 patients) found triamcinolone as effective as I&C for medium and large chalazia [S9]. An RCT from Pakistan (141 patients) found 62% success after one injection vs 79% after surgery, rising to 80% vs 89% after a second treatment, with depigmentation relatively common in pigmented skin [S1]. - Extralesional subcutaneous triamcinolone (0.3 mL of 10 mg/mL) outperformed conservative treatment (93.8% vs 58.3%) in a small RCT, as reported in [S2].

Incision and curettage - A meta-analysis of 8 RCTs: I&C succeeded in 78.0% after one procedure vs 60.4% for one steroid injection; complication rates did not differ [S5]. - Surgical excision remains effective for persistent lesions in children [S12].

Tier C (specialist centre)

• Recurrent or atypical lesions: biopsy and histology [S10].
• Children: topical antibiotics and steroids show mixed results with potential adverse effects; probiotics, omega-3 and intense pulsed light are experimental [S12].

Refer when

Pitfalls

• Repeating antibiotic drops for chalazion: no added benefit over hot compresses [S8].
• Injecting steroid where biopsy is needed [S4] [S10].
• Not warning patients with pigmented skin about depigmentation [S1].
• Missing systemic or skin associations in children [S12].

Evidence notes

• Definitions of resolution vary widely between chalazion studies [S11], so success rates are not directly comparable.
• The acupuncture trials lacked a valid sham control and had short follow-up [S7].
• Three-arm RCT outcomes were collected by telephone at 3 weeks [S3].
• Not covered by these sources: external hordeolum (stye) treatment trials, anaesthesia for I&C, and steroid-related intraocular pressure risk beyond the trial reports.

Related articles

• Eyelid Tumours: Basal Cell Carcinoma and Beyond
• Dry eye disease

References

See the numbered source list below. Each marker [S#] links to its PubMed and DOI record.