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Hordeolum and Stye in Emergency Medicine

  • Author: Michael J Bessette, MD, FACEP; Chief Editor: Robert E O'Connor, MD, MPH  more...
 
Updated: Nov 11, 2015
 

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 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.

A chalazion is a painless granuloma of the meibomian glands. The two entities may be distinguished based on the presence or absence of pain. The remainder of this article focuses on hordeolum.

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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

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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.

Chief Editor

Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Association for Physician Leadership, American Heart Association, Medical Society of Delaware, Society for Academic Emergency Medicine, Wilderness Medical Society, American Medical Association, National Association of EMS Physicians

Disclosure: Nothing to disclose.

Additional Contributors

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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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. 2005 May. 88(5):647-50. [Medline].

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

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

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

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

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

  7. Diegel JT. Eyelid problems. Blepharitis, hordeola, and chalazia. Postgrad Med. 1986 Aug. 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. 2000 Jul. 84(7):782-5. [Medline].

  9. Lederman C, Miller M. Hordeola and chalazia. Pediatr Rev. 1999 Aug. 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. 1991 Feb. 61(2):95-7. [Medline].

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

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

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Hordeolum pointing internally
Internal side of the same hordeolum
 
 
 
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