Introduction
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.
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.
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.
Clinical
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.
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.
- 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.
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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| Follow-up: Hordeolum and Stye |
| Multimedia: Hordeolum and Stye |
| References |
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References
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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].
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].
Lederman C, Miller M. Hordeola and chalazia. Pediatr Rev. Aug 1999;20(8):283-4. [Medline].
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].
Pavan-Langston D. Diagnosis and therapy of common eye infections: bacterial, viral, fungal. Compr Ther. May 1983;9(5):33-42. [Medline].
Raskin EM, Speaker MG, Laibson PR. Blepharitis. Infect Dis Clin North Am. Dec 1992;6(4):777-87. [Medline].
Further Reading
Keywords
chalazion, chalazia, infection of the eyelid margin, inflammation of the eyelid margin, external hordeolum, internal hordeolum, Staphylococcus aureus, Zeiss sebaceous glands, Moll sebaceous glands, meibomian glands, blepharitis, diabetes, seborrhea
