GPAtlas🧭 When to suspect
Suspect a stye (hordeolum) in anyone presenting with an acute, painful, red lump at the eyelid margin – in effect a small boil of the eyelid.
• A stye is an acute bacterial infection, almost always Staphylococcus aureus.
• External hordeolum: infection of a gland associated with an eyelash follicle (the glands of Zeis or Moll).
• Internal hordeolum: infection of a deeper meibomian gland.
A stye is common and usually self-limiting, settling within one to two weeks; the "head" often points and bursts within a few days.
• The eye itself and the vision are normal – the problem is confined to the lid.
• Confirm it is a stye, and treat with heat and lid hygiene rather than antibiotics.
• Recognise the few presentations that are not a simple stye: spreading infection (cellulitis), a red painful eye in a contact lens wearer, or a persistent atypical lid lesion.
Predisposing factors worth asking about include chronic blepharitis, rosacea, seborrhoeic dermatitis, diabetes, eye rubbing, and contact lens or eye make-up use.
| Eyelid lump | Distinguishing features |
|---|---|
| External hordeolum (stye) | • Acute, tender, red lump at the lash line • Often a yellow pustule at the base of a lash • Points outward |
| Internal hordeolum | • Acute, tender swelling on the inner (conjunctival) surface of the lid from an infected meibomian gland • Often more painful and slower to settle |
| Chalazion (meibomian cyst) | • Firmer, usually painless lump within the body of the lid • Sterile and chronic – antibiotics are not needed |
| Blepharitis | • Bilateral red, crusted, itchy lid margins rather than a discrete lump • The common driver of recurrent styes |
Source: College of Optometrists
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