Hordeolum and Stye in Emergency Medicine 

  • Author: Michael J Bessette, MD, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Feb 24, 2010
 

Background

A hordeolum (ie, stye) is a localized infection or inflammation of the eyelid margin involving hair follicles of the eyelashes (ie, external hordeolum) or meibomian glands (ie, internal hordeolum). A chalazion is a painless granuloma of the meibomian glands.

A hordeolum usually is painful, erythematous, and localized. It may produce edema of the entire lid. Purulent material exudes from the eyelash line in external hordeola, while internal hordeola suppurate on the conjunctival surface of eyelid.

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Pathophysiology

Staphylococcus aureus is the infectious agent in 90-95% of cases of hordeolum.

An external hordeolum arises from a blockage and infection of Zeiss or Moll sebaceous glands. An internal hordeolum is a secondary infection of meibomian glands in the tarsal plate. Both types can arise as a secondary complication of blepharitis.

Untreated, the disease may spontaneously resolve or it may progress to chronic granulation with formation of a painless mass known as a chalazion. Chalazia can be quite large and can cause visual disturbance by deforming the cornea. Generalized cellulitis of the eyelid may occur if an internal hordeolum is untreated.

Most morbidity is secondary to improper drainage. Proper technique and drainage precautions are described in Treatment.

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Epidemiology

Frequency

United States

Exact incidence of the disease is unknown, but it is a common entity.

International

No difference exists between US and international occurrence.

Sex

No sexual predilection exists.

Age

A slight increase in incidence is observed in the third to fifth decades of life.

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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

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  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine 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 

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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