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Hordeolum: Treatment & Medication

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
Coauthor(s): Kirk Alexander Sturridge, MD, Staff Physician, Department of Ophthalmology, State University of New York Downstate Medical Center
Contributor Information and Disclosures

Updated: May 21, 2009

Treatment

Medical Care

Hordeola are usually self-limited, spontaneously improving in 1-2 weeks.

Medical therapy for hordeola includes eyelid hygiene, warm compresses and massages of the lesions for 10 minutes 4 times per day, and topical antibiotic ointment in the inferior fornix if the lesion is draining or if there is an accompanying blepharoconjunctivitis.

Systemic antibiotics may be indicated if the hordeola is complicated by preseptal cellulitis. Oral doxycycline may also be added if there is a history of multiple or recurrent lesions or if there is significant and chronic meibomitis.

Internal hordeola may occasionally evolve into chalazia, which may require topical steroids, intralesional steroids, or surgical incision and curettage.

Surgical Care

Incision and drainage is indicated if the hordeolum is large or if it is refractory to medical therapy.

Incision and drainage is done under local anesthesia, and the incision is made through the skin and orbicularis (in the case of external hordeola) or through the tarsal conjunctiva and tarsus (in the case of internal hordeola). The specimen should be sent for histopathological evaluation to confirm the diagnosis and to rule out a more sinister pathology (eg, basal cell carcinoma).

Medication

The goals of pharmacotherapy are to treat the infection, to reduce morbidity, and to prevent complications.

Antibiotics

A course of oral antibiotics is indicated if the hordeolum is complicated by preseptal cellulitis.


Cephalexin (Keflex, Biocef, Keftab)

First-generation cephalosporin often used in skin or skin structure infections (eg, acute hordeolum) caused by staphylococci or streptococci. Administered orally and has a half-life of 50-80 min. Only 10% is protein bound and greater than 90% recovered unchanged in urine.

Adult

250 mg PO qid or 500 mg PO bid for 7-10 d

Pediatric

20 mg/kg/d PO divided q8h for 7-10 d; in more serious infections, may increase dose to 40 mg/kg/d; not to exceed 1 g/d

Coadministration with aminoglycosides increase nephrotoxic potential

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in severe renal insufficiency (high doses may cause CNS toxicity); superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy


Erythromycin (E-Mycin)

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Indicated for infections caused by susceptible strains of microorganisms and for prevention of corneal and conjunctival infections.

Adult

Apply 0.5-inch (1.25-cm) ribbon to affected eye 3 times/d

Pediatric

Apply as in adults

Documented hypersensitivity; viral, mycobacterial, and fungal infections of eye; patients using steroid combinations after uncomplicated removal of a foreign body from cornea should also avoid using this product

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Do not use topical antibiotics to treat ocular infections that may become systemic; prolonged or repeated antibiotic therapy may result in bacterial or fungal overgrowth of nonsusceptible organisms and may lead to a secondary infection (take appropriate measures if superinfection occurs)

More on Hordeolum

Overview: Hordeolum
Differential Diagnoses & Workup: Hordeolum
Treatment & Medication: Hordeolum
Follow-up: Hordeolum
References
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References

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

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

  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. 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].

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

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

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

  9. 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].

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Further Reading

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Keywords

hordeola, external hordeola, internal hordeola, chalazion, chalazia, stye, styes, eyelid disorder, eyelid infection

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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.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman 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; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching

CME Editor

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.

 
 
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