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. It is an acute bacterial infection, almost always Staphylococcus aureus, of a gland associated with an eyelash follicle (the glands of Zeis or Moll) in an external hordeolum, or of a deeper meibomian gland in an internal hordeolum.
A stye is common and usually self-limiting, settling within one to two weeks; the "head" often points and bursts within a few days. Crucially, the eye itself and the vision are normal – the problem is confined to the lid. The clinical task in primary care is therefore simple but important: confirm it is a stye, treat with heat and lid hygiene rather than antibiotics, and 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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