Pediatric Ophthalmology Services by Pediatric Eye MD

Services for Children

Chalazion and hordeolum (stye)

Within the eyelids are oil glands (Meibomian glands are located towards the back of the lid; Zeiss glands are towards the front); the oil produced by these glands is essential to normal tear film stability.  There are about 30 Meibomian glands in an upper eyelid and 20 in a lower lid; there is a Zeiss gland attached to every eyelash.  When one of these glands becomes clogged, the oil builds up and overflows, leaking into the eyelid.  Because these oils are normally excreted to outside of the body, the immune system treats the oil trapped within the eyelid as a foreign substance.  Initially, the oil leak is surrounded by an acute immune response– the area around the foreign body becomes red and swollen, and (often) tender.  When this happens to a Meibomian gland, it is called a chalazion.  Similarly, when a Zeiss gland extravasates oil, a hordeolum (stye) results.  Either way, there is a “pimple” within the lid – the appearance and management are the same.  (When a chalazion become chronic, a wall forms around the oil and this leaves a non-inflamed nodule under the skin that can take months or years to resorb.)

Step 1: Conservative Approach

Chalazion
Because the problem is an oil leak from one of our own oil glands, antibiotics play no role in treating a stye or chalazion.    What does work, however, is frequently applied hot compresses.   Hot compresses liquefy the oil and, hopefully, allow the clogged pore to open up and the oil to come out.    

If you place a towel under hot water, it will cool down very quickly.  Instead, heat a potato in the microwave and wrap a damp towel around it to create a compress that stays hot for a long time (and you can have a snack afterwards). My recommendation is to apply hot compresses 4 times a day for 5 to 10 minutes; this should be done for at least 2 to 4 weeks before saying “Well, we tried.”  Also, don’t be surprised if the eyelid skin becomes dry from the frequent compresses – apply a thin layer of AquaPhor (available over the counter) to the lid twice daily.

Step 2: Intervention

When hot compresses have been tried for a reasonable period of time, the stye/chalazion will either be gone or it won’t.  At this point, if you do nothing more the lesion will often just go away (resorb) on its own over a long period of time (months to years).  There is no danger to the eyeball from a chalazion, so leaving it alone is a perfectly reasonable option. 

However, if a chalazion is causing distress to you or your child, there are options. Through the miracle of modern surgery, we can drain these pesky pimples and restore your child’s eyelid. Surgery consists of flipping the eyelid over, making a small incision on the undersurface of the lid, and draining the goo out of the chalazion.   Sometimes, the skin of the eyelid is thinned out from the chalazion and breaks open during surgery; a dissolvable suture may be needed.   The risks of this surgery are infection, occurrence of a new chalazion (or stye) in a different gland, leaving behind some of the chalazion wall (this will eventually resorb, however), and minor bleeding.  For younger children, general anesthesia and a trip to the hospital are necessary for this.   For emotionally mature children (usually older than 9 years), good results can be obtained in the office by injecting steroid directly into the lesion – the greatest danger (though it is unlikely to occur) is depigmentation (a white spot) in the skin from the medication; this would be more of an problem for people of color.