Hordeolum Clinical Presentation

  • Author: Michael P Ehrenhaus, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 15, 2012
 

History

  • Hordeola essentially represent focal abscesses; therefore, they will present with features of acute inflammation, such as a painful, warm, swollen, red lump on the eyelid.
  • The eyelid lump may also induce corneal astigmatism and cause blurring of vision.
  • The patient often has a past history of similar eyelid lesions or risk factors for hordeola, such as meibomian gland dysfunction, blepharitis, or rosacea.[6]
  • Clinically differentiating hordeola from acute chalazia may be difficult, because they both present with acute inflammation and tender eyelid lumps. However, chronic chalazia represent a granulomatous reaction and, thus, appear firm and nontender on clinical examination.[4]
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Physical

On examination, a tender erythematous subcutaneous nodule is present near the eyelid margin, which may undergo spontaneous rupture and drainage. If sufficient edema is present, then it may be difficult to palpate a discrete nodule. These nodules may be unilateral or bilateral, single or multiple.

The inflammation associated with hordeola may spread to adjacent tissue and cause a secondary preseptal cellulitis.

Patients may also have signs of meibomitis, blepharitis, or ocular rosacea.[6]

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Causes

Hordeola are associated with S aureus infection.[3]

Patients with chronic blepharitis, meibomian gland dysfunction, and ocular rosacea are at greater risk of developing hordeola than the general population.[6]

There are published case reports where multiple recurrent hordeola have been associated with selective immunoglobulin M (IgM) deficiency.[7]

The lipid component of chalazia has been found to have large cholesterol content and is dissimilar to the lipid found in meibomian glands. Studies have reported an association between multiple chalazia and elevated serum cholesterol levels. Some studies have even suggested that elevated serum lipid levels may increase the risk of blockage to oil glands of the eyelids and, therefore, predispose to hordeola and chalazia.

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Contributor Information and Disclosures
Author

Michael P Ehrenhaus, MD  Director, Department of Cornea, External Disease & Refractive Surgery, Assistant Professor, Department of Ophthalmology, State University of New York Downstate Medical Center

Michael P Ehrenhaus, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and Contact Lens Association of Ophthalmologists

Disclosure: Nothing to disclose.

Coauthor(s)

Kirk Alexander Sturridge, MD  Staff Physician, Department of Ophthalmology, State University of New York Downstate Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Fernando H Murillo-Lopez, MD  Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; RPS Ownership interest Other; EyeGate Pharma Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting; Merck Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, George Alexandrakis, MD, to the development and writing of this article.

References

  1. American Academy of Ophthalmology. Eyelids. In: Ophthalmic Pathology and Intraocular Tumors. 4. San Francisco, CA: LEO; 2007-2008.

  2. American Academy of Ophthalmology. Infectious diseases of the external eye: clinical aspects. In: External Disease and Cornea. 8. San Francisco, CA: LEO; 2006-2007.

  3. Destafeno JJ, Kodsi SR, Primack JD. Recurrent Staphylococcus aureus chalazia in hyperimmunoglobulinemia E (Job's) syndrome. Am J Ophthalmol. Dec 2004;138(6):1057-8. [Medline].

  4. Lederman C, Miller M. Hordeola and chalazia. Pediatr Rev. Aug 1999;20(8):283-4. [Medline].

  5. Katowitz WR, Shields CL, Shields JA, Eagle RC Jr, Mulvey LD. Pilomatrixoma of the eyelid simulating a chalazion. J Pediatr Ophthalmol Strabismus. Jul-Aug 2003;40(4):247-8. [Medline].

  6. Raskin EM, Speaker MG, Laibson PR. Blepharitis. Infect Dis Clin North Am. Dec 1992;6(4):777-87. [Medline].

  7. Kiratli HK, Akar Y. Multiple recurrent hordeola associated with selective IgM deficiency. J AAPOS. 2001;5(1):60-1. [Medline].

  8. Shields JA, Demirci H, Marr BP, Eagle RC Jr, Shields CL. Sebaceous carcinoma of the eyelids: personal experience with 60 cases. Ophthalmology. Dec 2004;111(12):2151-7. [Medline].

  9. Panicharoen C, Hirunwiwatkul P. Current pattern treatment of hordeolum by ophthalmologists in Thailand. J Med Assoc Thai. Jun 2011;94(6):721-4. [Medline].

  10. Lindsley K, Nichols JJ, Dickersin K. Interventions for acute internal hordeolum. Cochrane Database Syst Rev. Sep 8 2010;CD007742. [Medline].

  11. Hosal BM, Zilelioglu G. Ocular complication of intralesional corticosteroid injection of a chalazion. Eur J Ophthalmol. Nov-Dec 2003;13(9-10):798-9. [Medline].

 
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