Hordeolum

Aka: Hordeolum, Stye, Internal Hordeolum, External Hordeolum

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II. Epidemiology

  1. More common in children and teenagers

III. Pathophysiology

  1. Types
    1. External Hordeolum (stye)
      1. External zeis (Sweat Gland) infection
    2. Internal Hordeolum
      1. Internal meibomian gland (Sebaceous Gland) infection
  2. Localized superficial abscess
    1. Usually caused by Staphylococcus aureus infection of the eyelash follicle

IV. Causes

  1. Staphylococcus aureus is most common infection

V. Risk Factors

  1. Rosacea
  2. Seborrhea
  3. Blepharitis
  4. Contact Lens wear
  5. Make-up or cosmetic application
  6. Poor Eyelid hygiene

VI. Symptoms

  1. Painful Eye Foreign BodySensation
  2. Lacrimation
  3. Photophobia

VII. Signs

  1. Rapid onset (12 to 24 hours)
    1. Starts as erythematous tender indurated lid area
    2. Later Pustule develops in area of Eyelid Inflammation
      1. Red, swollen, tender mass within Eyelid, at margin
  2. Types
    1. External Hordeolum (stye)
      1. Clogging of the eyelash follicles, or Zeis or Moll glands (Sweat Glands)
      2. Most common presentation
      3. Points to skin surface
    2. Internal Hordeolum
      1. Internal meibomian gland (Sebaceous Gland) infection or inflammation
      2. Points inward toward palpebral Conjunctiva
      3. Usually larger than External Hordeolum

VIII. Differential Diagnosis

  1. Chalazion
    1. Obstructed Sebaceous Gland
    2. Chronic, non-erythematous, non-fluctuant Nodule <1 cm
    3. Slow growing (developing over days to weeks)
  2. Blepharitis
  3. Eyelid neoplasm

IX. Management

  1. Most resolve spontaneously (even without intervention) within 1 to 2 weeks
  2. Warm compresses to eye for 15 minutes, four times daily
    1. Increases blood supply to area
    2. Increases spontaneous discharge
    3. Avoid harsh pressure
      1. Do noit attempt to "pop" the Hordeolum
  3. Daily cleansing of Eyelids
  4. Antibiotic ointment to Eyelid margin
    1. Erythromycin
    2. Bacitracin
    3. Avoid prolonged use in age under 12 years
      1. Blurred Vision (Amblyopia risk)
  5. 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

X. Complications

  1. Chalazion
    1. May develop from chronic Hordeolum
  2. Generalized lid Cellulitis or Preseptal Cellulitis
    1. Risk of Cavernous Sinus Thrombosis
    2. Add systemic coverage early for Staphylococcus aureus
  3. Recurrent Hordeolum
    1. Unilateral, chronic Staphylococcal infection
    2. Consider systemic antibiotics
    3. Refer to Ophthalmology

XI. References

  1. Carlisle (2015) Am Fam Physician 92(2): 106-12 [PubMed]
  2. O'Malley (2024) Am Fam Physician 109(2): 179-80 [PubMed]

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