Hordeolum and Stye in Emergency Medicine Clinical Presentation

  • Author: Michael J Bessette, MD, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 4, 2012
 

History

  • Patients usually complain of a localized painful swelling on one eyelid.
  • In some cases, the complaint may start as a generalized edema and erythema of the lid that later becomes localized.
  • A history of similar problems is common.
  • Constitutional signs and symptoms are inconsistent with a hordeolum diagnosis. In extreme cases, the infection can spread to involve the entire lid and even the periorbital tissues. Such cases do not respond to normal hordeolum management and must be managed as periorbital cellulitis.
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Physical

Completely examine the area around the orbit, the eye, and the conjunctival surface. Carefully inspect the underside of the eyelid to avoid missing an internal hordeolum.

  • Examination reveals a localized tender area of swelling with a pointing eruption either on the internal or on the external side of eyelid. See the images below. Hordeolum pointing internally Hordeolum pointing internally Internal side of the same hordeolum Internal side of the same hordeolum
  • Occasionally, the hordeolum points on both sides.
  • Infection of conjunctiva is a common secondary finding.
  • Examination of preauricular nodes can help to identify spread of the disease beyond a simple hordeolum. Nodes should not be swollen in patients with a simple hordeolum.
  • No intraocular pathology should be found.
  • Presence of fever or distant nodes indicates systemic disease.
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Causes

  • Staphylococcal organisms are the most common causes of eyelid infections, but other organisms may be involved.
  • Hordeola are found more frequently in persons who have the following:
    • Diabetes
    • Other debilitating illness
    • Chronic blepharitis
    • Seborrhea
    • High serum lipids (High lipid levels increase the blockage rate of sebaceous glands, but lowering of serum lipid levels in these patients has not decreased frequency of recurrence.)
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Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Michael J Bessette, MD, FACEP  Director of Emergency Medicine, Jersey City Medical Center

Michael J Bessette, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Robin R Hemphill, MD, MPH  Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine

Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

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

Douglas Lavenburg, MD  Clinical Professor, Department of Emergency Medicine, Christiana Care Health Systems

Douglas Lavenburg, MD is a member of the following medical societies: American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Hirunwiwatkul P, Wachirasereechai K. Effectiveness of combined antibiotic ophthalmic solution in the treatment of hordeolum after incision and curettage: a randomized, placebo-controlled trial: a pilot study. J Med Assoc Thai. May 2005;88(5):647-50. [Medline].

  2. Barza M, Baum J. Ocular infections. Med Clin North Am. Jan 1983;67(1):131-52. [Medline].

  3. Benton J, Karkanevatos A. Preseptal cellulitis due to Mycobacterium marinum. J Laryngol Otol. Jun 2007;121(6):606-8. [Medline].

  4. Brafman AH. Styes: a curious chain. Br J Gen Pract. Dec 1992;42(365):537-8. [Medline].

  5. Briner AM. Surgical treatment of a chalazion or hordeolum internum. Aust Fam Physician. Jun 1987;16(6):834-5. [Medline].

  6. Briner AM. Treatment of common eyelid cysts. Aust Fam Physician. Jun 1987;16(6):828, 830. [Medline].

  7. Diegel JT. Eyelid problems. Blepharitis, hordeola, and chalazia. Postgrad Med. Aug 1986;80(2):271-2. [Medline].

  8. Jackson TL, Beun L. A prospective study of cost, patient satisfaction, and outcome of treatment of chalazion by medical and nursing staff. Br J Ophthalmol. Jul 2000;84(7):782-5. [Medline].

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

  10. Olson MD. The common stye [published erratum appears in J Sch Health 1991 Mar;61(3):138]. J Sch Health. Feb 1991;61(2):95-7. [Medline].

  11. Pavan-Langston D. Diagnosis and therapy of common eye infections: bacterial, viral, fungal. Compr Ther. May 1983;9(5):33-42. [Medline].

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

 
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Hordeolum pointing internally
Internal side of the same hordeolum
 
 
 
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