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

V. Risk Factors

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

VI. Symptoms

VII. Signs

  1. Onset as erythematous tender indurated lid area
  2. Later Pustule develops in area of Eyelid Inflammation
    1. Red, swollen, tender mass within Eyelid, at margin
  3. Types
    1. External Hordeolum (stye, external zeis or Sweat Gland)
      1. Most common presentation
      2. Points to skin surface
    2. Internal Hordeolum (internal meibomian or Sebaceous Gland infection)
      1. Points inward toward palpebral Conjunctiva
      2. Usually larger than External Hordeolum

VIII. Differential Diagnosis

IX. 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. Bacitracin
    3. 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

X. Complications

  1. Chalazion
    1. May develop from chronic Hordeolum
  2. Generalized lid 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

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