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FIGURE 123.13 Acute stye (external hordeolum).

Both conditions may present acutely with localized lid swelling, erythema, and
tenderness. Styes are associated with swelling and purulent drainage at or near the
lid margin ( Fig. 123.13 ). More than one lesion may occur simultaneously, and
more than one lid may be involved. An acute chalazion causes swelling and
redness in the body of the eyelid and may be associated with drainage on the
conjunctival surface of the eyelid with or without a red eye. It may also drain via
the skin ( Fig. 123.14 ). A chalazion typically enters a chronic granulomatous
phase in which there is a nontender, noninflamed, mobile pea-sized nodule within
the body of the eyelid ( Fig. 123.15 ). History can be helpful in establishing these
diagnoses because patients often have had recurrent lesions in the same or other
eyelid.