Background
A hordeolum is a common disorder of the eyelid.[1] It is an acute focal infection (usually staphylococcal) involving either the glands of Zeis (external hordeola, or styes) or, less frequently, the meibomian glands (internal hordeola).[2]
Pathophysiology
There is usually underlying meibomitis with thickening and stasis of gland secretions with resultant inspissation of the Zeis or meibomian gland orifices. Stasis of the secretions leads to secondary infection, usually by Staphylococcus aureus.[3] Histologically, hordeola represent focal collections of polymorphonuclear leukocytes and necrotic debris (ie, an abscess).
Hordeola should not be confused with chalazia, which represent focal, chronic, lipogranulomatous inflammation of the Zeis or meibomian glands.[4] Chalazia form when underlying meibomitis results in stasis of gland secretions, and the contents of the glands (sebum) are released into the tarsus and adjacent tissues to incite a noninfectious inflammatory reaction. Histologically, chalazia appear as a granulomatous reaction (ie, histiocytes, multinucleated giant cells) surrounding clear spaces that were once occupied by sebum/lipid before they were dissolved by the solvents used for tissue processing, hence the term lipogranuloma.
Essentially, a hordeolum represents an acute focal infectious process, while a chalazion represents a chronic, noninfectious granulomatous reaction. However, chalazia often evolve from internal hordeola.[5]
Epidemiology
Frequency
United States
Hordeola are common in clinical practice, but no data are available on the precise incidence and prevalence in the United States.
International
No data are available on the incidence and prevalence of hordeola internationally. However, hordeola are among the most common eyelid lesions in clinical practice.
Race
There is no known racial predilection to developing hordeola.
Sex
There is no sexual predilection to developing hordeola. Both men and women seem to be equally affected.
Age
Hordeola are more common in adults than in children, possibly because of a combination of higher androgenic levels (and increased viscosity of sebum), higher incidence of meibomitis, and rosacea in adults. However, hordeola can occur in children.
American Academy of Ophthalmology. Eyelids. In: Ophthalmic Pathology and Intraocular Tumors. 4. San Francisco, CA: LEO; 2007-2008.
American Academy of Ophthalmology. Infectious diseases of the external eye: clinical aspects. In: External Disease and Cornea. 8. San Francisco, CA: LEO; 2006-2007.
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].
Lederman C, Miller M. Hordeola and chalazia. Pediatr Rev. Aug 1999;20(8):283-4. [Medline].
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].
Raskin EM, Speaker MG, Laibson PR. Blepharitis. Infect Dis Clin North Am. Dec 1992;6(4):777-87. [Medline].
Kiratli HK, Akar Y. Multiple recurrent hordeola associated with selective IgM deficiency. J AAPOS. 2001;5(1):60-1. [Medline].
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].
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].
Print
