Hordeolum

1. See Also
   1. Chalazion
2. Epidemiology
   1. More common in children and teenagers
3. Pathophysiology
   1. Affects EyelidSebaceous Gland (gland of zeis)
   2. Localized superficial abscess
      1. Usually caused by Staphylococcus aureus
4. Causes
   1. Staphylococcus organisms
   2. Seborrhea
5. Risks
   1. Blepharitis
   2. Contact lens wear
   3. Make-up or cosmetic application
   4. Poor Eyelid hygiene
6. Symptoms
   1. Painful Eye Foreign Body sensation
   2. Lacrimation
   3. Photophobia
7. Signs
   1. Onset as erythematous tender indurated lid area
   2. Later Pustule develops in area of lid inflammation
      1. Red, swollen, tender mass within lid
   3. Types
      1. External Hordeolum
         1. Most common presentation
         2. Points to skin surface
      2. Internal Hordeolum
         1. Points inward toward palpebral Conjunctiva
         2. Usually larger than external Hordeolum
8. Differential Diagnosis
   1. Chalazion
   2. Blepharitis
   3. Eyelid neoplasm
9. Management
   1. Warm compresses to eye for 15 minutes qid
      1. Increases blood supply to area
      2. Increases spontaneous discharge
   2. Daily cleansing of Eyelids
   3. Antibiotic ointment to Eyelid margin
      1. Erythromycin
      2. Avoid prolonged use in age under 12 years
         1. Blurred vision (Amblyopia risk)
   4. Incision, Drainage and Curettage
      1. Indications
         1. Single gland involvement
         2. Failed improvement after 48 hours
      2. In-office procedure under local anesthetic
         1. May be performed by non-ophthalmologist
10. Complications
    1. Generalized lid Cellulitis
       1. Risk of Cavernous Sinus Thrombosis
       2. Add systemic coverage early for Staphylococcus aureus
    2. Recurrent Hordeolum
       1. Unilateral, chronic Staphylococcal infection
       2. Consider systemic antibiotics
       3. Refer to Ophthalmology