Blepharitis vs. Stye: How to Tell the Difference (and Treat Both)

Waking up with a red, swollen, and painful eyelid is an uncomfortable experience that immediately raises questions. Is it an infection? An irritation? Two of the most common culprits are blepharitis and a stye, and while they share similar symptoms, they are fundamentally different conditions requiring distinct approaches to treatment.

Understanding the difference is the first step toward relief. A stye is an acute, localized infection, much like a pimple, while blepharitis is a chronic, widespread inflammation of the entire eyelid margin.

At a Glance: Blepharitis vs. Stye Key Differences

For a quick diagnosis, here’s how the two conditions stack up. The primary giveaway is whether you have a single, painful lump or generalized irritation.

Feature	Stye (Hordeolum)	Blepharitis
What It Is	An acute bacterial infection of an oil gland or eyelash follicle.	A chronic inflammation of the eyelid margins.
Main Symptom	A single, painful, red lump that looks like a pimple.	Widespread redness, itching, burning, and crusty flakes along the entire eyelash line.
Cause	Bacterial infection, most commonly Staphylococcus aureus.	Bacteria, clogged meibomian glands, or skin conditions like rosacea and dandruff.
Onset/Duration	Appears suddenly and typically resolves within a week or two.	A long-term condition with flare-ups that require ongoing management.
Location	A localized bump on the edge of the eyelid or under it.	Affects the entire length of the eyelid margin.

What is a Stye (Hordeolum)?

A stye, medically known as a hordeolum, is a tender red bump that forms at the edge of the eyelid. Think of it as an abscess or a small boil. It happens when a tiny oil gland (meibomian gland) or eyelash follicle becomes clogged with dead skin cells and oil, allowing bacteria to multiply.

A close-up image showing a stye on the upper eyelid. Image of a stye on the upper eyelid. Image by Amanda Dalbjörn on Unsplash.

Causes of a Stye

The vast majority—90% to 95%—of styes are caused by a Staphylococcus aureus bacterial infection. You are at a higher risk of developing a stye if you:

• Touch your eyes with unwashed hands.
• Have chronic blepharitis.
• Use contaminated or old eye makeup.
• Leave makeup on overnight.
• Have skin conditions like rosacea or seborrheic dermatitis.

Symptoms of a Stye

While the lump is the main event, other symptoms often accompany a stye:

• A distinct, painful, and tender red lump on the eyelid margin.
• Swelling of the eyelid.
• A small pus spot at the center of the bump.
• A feeling of having something in your eye.
• Crusting along the eyelid.
• Tearing and light sensitivity.

What is Blepharitis?

Blepharitis is not a single bump but a chronic and persistent inflammation of the eyelids. It makes the eyelid margins red, irritated, itchy, and often results in dandruff-like scales on the eyelashes. It is a common condition that can be difficult to manage due to its recurring nature.

Causes and Types of Blepharitis

Blepharitis is generally categorized by its location, as noted by the National Eye Institute (NEI):

• Anterior Blepharitis: Affects the outer front edge of the eyelid where the eyelashes are attached. It's typically caused by bacteria (Staphylococcus) or dandruff from the scalp and eyebrows (seborrheic dermatitis).
• Posterior Blepharitis: Affects the inner edge of the eyelid that touches the eyeball. This is usually caused by problems with the oil (meibomian) glands within the eyelids, a condition known as Meibomian Gland Dysfunction (MGD). Skin conditions like rosacea are often linked to posterior blepharitis.

Symptoms of Blepharitis

Symptoms can vary but almost always affect both eyes:

• Red, swollen, or itchy eyelids.
• A gritty or burning sensation in the eyes.
• Crusty debris or dandruff-like flakes at the base of the eyelashes, especially upon waking.
• Foamy tears.
• Dry eyes.
• Sensitivity to light.
• In severe cases, blurred vision or eyelashes falling out (madarosis).

Video by Narayana Nethralaya Eye Hospital explaining the causes and treatments for styes and blepharitis.

The Vicious Cycle: How Blepharitis and Styes are Connected

It's crucial to understand that these two conditions are not mutually exclusive. In fact, chronic blepharitis is a primary risk factor for developing recurrent styes.

The ongoing inflammation, excess bacteria, and clogged oil glands from blepharitis create a perfect breeding ground for the acute infection that leads to a stye. If you find yourself getting styes repeatedly, there's a strong possibility that underlying, unmanaged blepharitis is the root cause.

Expanding the Differential Diagnosis: What About a Chalazion?

To make matters more confusing, a third common lump, a chalazion, often enters the picture. While a stye is an infection, a chalazion is a blockage.

A chalazion is a swollen bump on the eyelid that occurs when a meibomian gland becomes clogged. Unlike a stye, it's typically not infected and is usually painless.

Feature	Stye (Infection)	Chalazion (Blockage)
Pain	Painful and tender	Usually painless
Location	At the very edge of the eyelid	Further back on the eyelid
Appearance	Red, sore, pimple-like, often with a pus head	Firm, rubbery, smooth lump

An unresolved internal stye can sometimes develop into a chalazion. Both blepharitis and styes can increase your risk of developing a chalazion.

A diagram comparing the appearance and location of a stye and a chalazion on an eyelid. Source: American Academy of Ophthalmology

Treatment Philosophies: Acute Fix vs. Chronic Care

Because a stye is an acute infection and blepharitis is a chronic condition, their treatment strategies are very different.

How to Treat a Stye (Acute Resolution)

The goal is to help the stye drain and clear the infection. Most styes resolve within a week with simple home care.

• Apply Warm Compresses: Soak a clean washcloth in warm water and hold it over the affected eye for 10-15 minutes, 3-4 times a day. This is the single most effective treatment to promote drainage.
• Keep it Clean: Gently clean the area with mild soap and water.
• Avoid Makeup and Contacts: Do not wear eye makeup or contact lenses until the stye has fully healed.
• DO NOT SQUEEZE: Never try to pop or squeeze a stye. This can spread the infection deeper into your eyelid tissue and cause serious complications.
• Medical Treatment: If the stye is very painful, affects your vision, or doesn't improve, an eye doctor might prescribe an antibiotic ointment or, in some cases, make a small incision to drain it.

How to Manage Blepharitis (Chronic Care)

There is no cure for blepharitis, but its symptoms can be controlled with a consistent, daily hygiene routine. This is a lifelong management plan, not a short-term fix.

The cornerstone of blepharitis management is a three-step process:

1. Warmth: Apply a warm compress for 5-10 minutes to liquefy the oily secretions in the meibomian glands.
2. Massage: Gently massage your eyelids to help push the oils out of the glands.
3. Cleansing: Use a clean washcloth, cotton swab, or a commercial lid scrub with a gentle cleanser (like diluted baby shampoo) to scrub along the lash line and remove debris.

Your doctor may also recommend:

• Antibiotics: Ointments or oral antibiotics to reduce bacteria on the eyelids.
• Steroid Eye Drops: To control inflammation.
• Artificial Tears: To relieve dry eye symptoms.
• Dietary Supplements: Omega-3 fatty acids may help improve the function of the meibomian glands.

When to See an Eye Doctor

While many cases can be managed at home, you should consult an ophthalmologist or optometrist if:

For a Stye:

• It doesn't start to improve after a few days of home treatment.
• The swelling and redness spread to your entire eyelid or cheek.
• It is extremely painful.
• It affects your vision.

For Blepharitis:

• Your symptoms are severe and not improving with a daily cleaning routine.
• You develop frequent styes.
• You experience changes to your vision.
• You notice sores or damage to your eyelid.

References

1. American Academy of Ophthalmology (AAO). (2024). What Are Chalazia and Styes?. aao.org
2. Cleveland Clinic. (2022). Blepharitis (Eyelid Inflammation). my.clevelandclinic.org
3. Healthline. (2022). Blepharitis vs. Stye: Symptoms, Causes, and Treatment. healthline.com
4. Medical News Today. (2024). Stye vs. blepharitis: Symptoms, treatment, and more. medicalnewstoday.com
5. National Eye Institute (NEI). (2023). Blepharitis. nei.nih.gov
6. Verywell Health. (2024). Blepharitis vs. Stye: Symptoms, Causes, and Treatment. verywellhealth.com