Introduction
Background
A hordeolum is a common disorder of the eyelid. 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).
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. 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. 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.
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.
Clinical
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.
- 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.
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.
Causes
Hordeola are associated with S aureus infection.
Patients with chronic blepharitis, meibomian gland dysfunction, and ocular rosacea are at greater risk of developing hordeola than the general population.
There are published case reports where multiple recurrent hordeola have been associated with selective immunoglobulin M (IgM) deficiency.
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.
More on Hordeolum |
 Overview: Hordeolum |
| Differential Diagnoses & Workup: Hordeolum |
| Treatment & Medication: Hordeolum |
| Follow-up: Hordeolum |
| References |
| Next Page » |
References
American Academy of Ophthalmology. Infectious diseases of the external eye: clinical aspects. In: External Disease and Cornea. 8. San Francisco, CA: LEO; 2006-2007.
American Academy of Ophthalmology. Eyelids. In: Ophthalmic Pathology and Intraocular Tumors. 4. San Francisco, CA: LEO; 2007-2008.
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].
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].
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].
Kiratli HK, Akar Y. Multiple recurrent hordeola associated with selective IgM deficiency. J AAPOS. 2001;5(1):60-1. [Medline].
Lederman C, Miller M. Hordeola and chalazia. Pediatr Rev. Aug 1999;20(8):283-4. [Medline].
Raskin EM, Speaker MG, Laibson PR. Blepharitis. Infect Dis Clin North Am. Dec 1992;6(4):777-87. [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].
Further Reading
Keywords
hordeola, external hordeola, internal hordeola, chalazion, chalazia, stye, styes, eyelid disorder, eyelid infection
