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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Related Studies

Ontology: Hordeolum (C0019917)

Definition (MSHCZE) Lat. ječné zrno. Ohraničený hnisavý zánět, často stafylokokového původu, některé ze žlázek víčka (kolem vlasového míšku) provázený otokem, zarudnutím, bolestí a později někdy patrným zhnisáním. H. se může vyprázdnit samovolně, vhodnější je incize s místním podáním antibiotik. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (MSH) Purulent infection of one of the sebaceous glands of Zeis along the eyelid margin (external) or of the meibomian gland on the conjunctival side of the eyelid (internal).
Concepts Disease or Syndrome (T047)
MSH D006726
ICD10 H00.01
SnomedCT 74612003, 155172004, 267736000, 193912000, 193913005, 397513003, 1489008
English Hordeolum, Stye, Styes, Hordeolum NOS, Hordeolum [Disease/Finding], sty, stye, styes, hordeolum externum, Stye/hordeolum, Boil of eyelid, Furuncle of eyelid, Stye (disorder), Hordeolum (disorder), hordeolum, Hordeolum, NOS, Sty
Swedish Vagel
Japanese ﾊﾞｸﾘｭｳｼｭ, 麦粒腫, ものもらい
Czech hordeolum, ječné zrno, Ječné zrno, Hordeolum, zánět Zeissovy žlázy
Finnish Luomirauhasen tulehdus
Russian IACHMEN', ЯЧМЕНЬ
Polish Zapalenie gruczołów tarczkowych powiek, Jęczmyk, Jęczmień-choroba
Hungarian Jégárpa, hordeolum, Árpa
Norwegian Hordeolum, Sti på øyet
Spanish orzuelo (concepto no activo), forúnculo del párpado, orzuelo (trastorno), orzuelo, Orzuelo
Dutch hordeolum, Hordeolum, Strontje
French Orgelet, Compère-loriot, Hordeolum, Hordéole
German Gerstenkorn, Hordeolum
Italian Orzaiolo
Portuguese Hordéolo, Terçol
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Hordeolum externum (C0019919)

Concepts Disease or Syndrome (T047)
ICD9 373.11
ICD10 H00.01 , H00.03
SnomedCT 1489008, 61523007, 193912000
English Hordeolum, Stye, furuncles on eyelid (physical finding), furuncles on eyelid, hordeolum externum, stye, hordeolum externum (diagnosis), Eyelid boil, external hordeolum, hordeolum external, externum hordeolum, sty external, Hordeolum, external, Furuncle of eyelid (disorder), External hordeolum, Hordeolum externum (disorder), Hordeolum externum, eyelid; furuncle, furuncle; eyelid, Furuncle of eyelid, Boil of eyelid
Italian Foruncolo della palpebra, Orzaiolo esterno, Orzaiolo superficiale
Dutch hordeolum externum, furunkel; ooglid, ooglid; furunkel, ooglidfurunkel
French Orgelet externe, Furoncle de la paupière
German Hordeolum externum, externes Hordeolum, Furunkel des Augenlids
Portuguese Hordéolo externo, Furúnculo palpebral
Spanish Orzuelo externo, Forúnculo del párpado, forúnculo del párpado, furúnculo del párpado, forúnculo del párpado (concepto no activo), chalazión externo (trastorno), chalazión externo, orzuelo externo (trastorno), orzuelo externo
Japanese 外麦粒腫, 眼瞼せつ, ｶﾞﾝｹﾝｾﾂ, ｶﾞｲﾊﾞｸﾘｭｳｼｭ
Czech Hordeolum externum, Furunkl očního víčka
Hungarian szemhéj kelés, Külső hordeolum, Hordeolum externum
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Internal hordeolum (C0085690)

Concepts Disease or Syndrome (T047)
ICD9 373.12
ICD10 H00.02
SnomedCT 397514009, 15750009, 95752007, 414521009
Dutch hordeolum internum
French Orgelet interne
German Hordeolum internum, internes Hordeolum
Italian Orzaiolo interno
Portuguese Hordéolo interno
Spanish Orzuelo interno, orzuelo interno (concepto no activo), orzuelo interno (trastorno), orzuelo interno
Japanese 内麦粒腫, ﾅｲﾊﾞｸﾘｭｳｼｭ
English hordeolum internum, hordeolum internum (diagnosis), internal hordeolum, Hordeolum internum (disorder), Internal hordeolum, Hordeolum internum, Internal hordeolum (disorder)
Czech Hordeolum internum
Hungarian Belső hordeolum, Hordeolum internum
Derived from the NIH UMLS (Unified Medical Language System)

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