Stye vs chalazion: telling eyelid lumps apart

A stye is the painful one. The NHS describes it as a small, painful lump on or inside the eyelid or around the eye, usually on one eye, often with a red, swollen area of skin and sometimes a yellow head of pus. A chalazion is the firm one. The College of Optometrists says it is usually felt as a small firm lump in the upper or lower eyelid, and the NHS says a hard lump that is not very painful is more likely to be a chalazion.

The two are related, because both involve the oil glands and follicles of the eyelid, and both are common. But they are different processes: a stye is an acute infection, while a chalazion is a blockage that leads to a lump. Neither is usually a sign of anything serious, and both can often be managed at home.

The NHS says styes are common and rarely a sign of anything serious, although they can be painful until they heal. They are often caused by bacteria infecting an eyelash follicle or an eyelid gland, and you are more likely to get one if you have long-term blepharitis or rosacea. Your eye may be red and watery, but your vision should not be affected.

A chalazion, also called a Meibomian cyst, is a common eyelid condition caused by blockage of the openings of the oil-producing Meibomian glands, according to the College of Optometrists. The College describes it as a chronic lipogranulomatous lesion. Predisposing factors include chronic blepharitis, rosacea, seborrhoeic dermatitis, pregnancy and diabetes.

The table summarises how the NHS and the College of Optometrists describe each.

The NHS says it is probably not a stye if there is no lump. If your eye or eyelid is swollen, red and watery, it is more likely to be conjunctivitis or blepharitis. If the lump is hard but not very painful, it is more likely to be a chalazion. This is helpful because several different eyelid and eye surface problems are described as a lump or a red eye.

Any lump that is not behaving as described, that is growing, bleeding or not going away, should be looked at by a clinician rather than assumed to be a stye or chalazion.

For a stye, the NHS suggests soaking a clean flannel in warm water and holding it against the eye for 5 to 10 minutes, 2 to 4 times a day, and taking painkillers such as paracetamol or ibuprofen for pain (aspirin should not be given to children under 16). It advises avoiding contact lenses and eye make-up until the stye has burst and healed, and not to share towels or flannels or rub your eyes if you have not washed your hands. Cleaning the lids and lashes matters if you have blepharitis.

For a chalazion, the College of Optometrists says the condition usually gets better with a combination of warm compresses and massage, and that if it does not settle, it can be treated with a steroid injection or the cyst can be removed in a minor operation under local anaesthetic.

The NHS says to see a GP if a stye does not get better within a few weeks. It says to ask for an urgent GP appointment or call NHS 111 if the stye is very painful or swollen, affects your vision, your eye is producing pus or the infection has spread to your eye or eyelid. A GP may burst the stye with a thin sterilised needle, remove the eyelash closest to it or refer you to an eye specialist in hospital.

If you get styes or lumps repeatedly, it is worth asking about the underlying eyelid condition, because the NHS and the College of Optometrists both link them with blepharitis and rosacea.