How can I differentiate between a chalazion and a hordeolum during a clinical examination?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

During a clinical examination, a chalazion typically presents as a painless, firm, localized swelling of the eyelid that is usually non-tender and has a gradual onset .

In contrast, a hordeolum (stye) is generally painful, tender, and has a more acute onset, often associated with localized erythema and swelling of the eyelid margin .

A chalazion tends to be a deeper, more indurated lump that may be located away from the eyelid margin, whereas a hordeolum is often situated at the eyelid margin, involving the eyelash follicle or meibomian gland ,.

Additionally, a hordeolum may show signs of active infection such as pus or a pustule, while a chalazion usually does not have purulent discharge ,.

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