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Peter Fries, M.D.

Several different types of red, swollen and tender bumps can arise on the edge or inside portions of an eyelid. Frequently these bumps are infectious or inflammatory processes within the different oil, sweat and tear glands of the eyelid. Most people are familiar with what a stye looks like but not what it is – a red, tender lump with a whitehead on the skin edge of the eyelid from an infection in a sweat gland at the base of an eyelash. While we may be more familiar with the term stye, most red, tender bumps on the eyelids are not infectious styes. Specialized oil glands that empty along the edge of the eyelid can become plugged then rupture causing an inflammatory reaction in the eyelid that mimics a stye. These tender, red, inflamed bumps are termed chalazions.

Why does this matter? Both are red, tender, ugly and often associated with a mucous discharge from the eye. While similar in appearance, how they are managed and treated is very different. Styes often have a whitehead in its center which is the sealed collection of infection in the sweat gland along the shaft of the eyelash that usually can be found poking out of the center of the stye. Hot compresses can help bring this to a head so it drains which is quickly curative for the stye. If a lash is visible, plucking this starts the drainage process with quick results. Antibiotic drops are often added along with hot compresses for several days to be sure no other infections start. This whole process is usually over in days.

Chalazions have a very different course and treatment response than a stye. These red lumps are not caused by infections. The oil gland becomes plugged causing the pressure to build within the gland until it ruptures, spilling the oily secretions into the surrounding tissue layers. Depending on what part of the gland ruptures, the chalazion can be on the inside or outside of the eyelid, on the edge or well below the eyelashes. The oils are irritating to the tissue layers and typically set up an inflammatory reaction that causes the lid to become red, swollen and tender. Sounds like a stye, doesn’t it? Usually there is no whitehead although if the inflammation is close to the surface, the skin can thin and allow oils to come out. If no treatment is begun, the swelling and redness decrease over 1 to 2 weeks and leaves a hard lump which is the trapped oils surrounded by a thin wall of scar tissue that keeps it from spreading. This slows down how quickly the body can absorb the oils and causes these nontender lumps to remain for weeks or months.

Antibiotics do not work well to treat chalazions since there is usually no infection that starts the process. That is often why a “stye” doesn’t go away with hot compresses and antibiotic drops – it’s not a stye but a chalazion. Still, early treatment with frequent hot soaks and massage over the backed up oil gland are sometimes an effective treatment for chalazions. The plug may dislodge allowing the oil gland to drain through its natural orifice and the heat helps to loosen the oils internally so that they can flow out. This needs to be done frequently from the time the lump appears, often as frequently as every hour to be effective. Antibiotic drops are sometimes added if there is suspicion of a preexisting infection.

Chalazions that persist and end up as a firm, non-tender lump in the eyelid can be treated with a variety of techniques. If still inflamed, steroid injections around the bump can help it to settle and even shrink completely away over days or weeks since the cortisone slows down the inflammatory response and reduces swelling and scarring. Persistent lumps that are unsightly or bother vision can be incised and the trapped oils removed through a small incision into the lump from the inside of the eyelid. This is often done in the doctor’s office under local anesthesia and is usually performed when more conservative treatments has failed to work. Perhaps the most neglected treatment for chalazions is time. Almost all of these will be reabsorbed by the body given enough time which unfortunately is often measured in months.

Chalazions frequently arise in individuals who have certain inflammatory skin or oil gland disorders such as rosacea and seborrhea. In these cases, treating the underlying skin and oil gland disorder will also help to eliminate the chalazion. Tetracycline or doxycycline, an oral antibiotic that is effective for these disorders, can not only help to eliminate the current chalazion but also clean out the other oil glands to help prevent future ones. While not curative, it can be used effectively on future occasions when these conditions start to return. Most individuals with multiple or recurrent chalazions have an underlying chronic skin or oil gland condition that affects the oil glands in the lid as well.

Effective treatments are available for these red, tender lumps. Starting frequent hot compresses when they first arise works well for styes and may work for chalazions. Persistence of the bump, significant discharge from the eye or similar inflammatory acne or facial bumps should prompt a visit to your doctor to have these checked and to determine which might be the best treatment for you.

BIO: Dr. Peter Fries

The material contained in this article is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider.

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