When a Stye Doesn’t Go Away: The Hidden Pyogenic Granuloma

I recently saw a 30-year-old man who had something unusual going on with his lower eyelid. Some days, everything looked normal—but on other days, he could see a small red bump tucked between his eyeball and the inside of his eyelid. At first, he was able to shift the bump by moving his eyelid, but over time, it began to grow and become more noticeable.

He also mentioned waking up with thick mucus and eye redness, especially in the morning. There was no pain and no swelling of the outer eyelid skin, which made the diagnosis more subtle. But as soon as I examined him, I knew what it was: a pyogenic granuloma.

This type of lesion grows on the inner surface of the eyelid and can sometimes appear after a stye or minor trauma. It’s shaped like a small red mushroom—attached to the eyelid by a thin stalk, with a central blood vessel feeding it. Patients often notice morning mucus or crusting, and in some cases, it may even bleed slightly if rubbed.

He did recall having a stye a few months ago that mostly resolved, and I could feel the small, firmer bump from the residual chalazion still under the skin.

There are several treatment options:

• Short course of anti-inflammatory eyedrops for smaller granulomas
• Steroid injection if there’s an active stye
• Surgical removal under local anesthesia for larger lesions

In his case, the granuloma was too large for drops, and the stye was too subtle for an injection—so I went ahead with surgical excision.