eMedicine Specialties > Emergency Medicine > Ophthalmology
Hordeolum and Stye: Treatment & Medication
Updated: Mar 11, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
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Treatment
Emergency Department Care
- Drainage of a hordeolum
- Perform drainage with stab incisions at the site of pointing using an 18-gauge needle or a #11 blade. External incisions lead to scarring, so making external eyelid incisions or punctures is inadvisable, unless the hordeolum already is pointing externally.
- A large abscess may have multiple pockets and require multiple stabs.
- Internal incisions should be made vertically to minimize the area of cornea swept by a scar during blinking; external incisions should be made horizontally for optimal cosmesis.
- Hold the lesion with a chalazion clamp.
- To avoid disrupting normal growth of lashes, do not make incisions along eyelash margins.
- Leave the incision open with a clean margin.
- When draining a lesion that points both externally and internally, make the incision internally and as far as possible from the site of external pointing. Combined overlying internal and external drainage increases the risk of later fistulae through the lid.
- Do not inject local anesthesia directly into the hordeolum; inject along the lid margins in a line above the upper tarsus or below the lower tarsus.
- Do not attempt to remove all seemingly purulent material if acute inflammation is present; excessive loss of tarsal tissue and lid deformity may result.
- Hordeola usually are self-limited even without drainage. Most hordeola eventually point and drain by themselves.
- Warm soaks (qid for 15 min) are the mainstays of treatment.
- Antibiotics are indicated only when inflammation has spread beyond the immediate area of the hordeolum.
- Topical antibiotics may be used for recurrent lesions and for those that are actively draining. Topical antibiotics do not improve the healing of surgically drained lesions.
- Systemic antibiotics are indicated if signs of bacteremia are present or if the patient has tender preauricular lymph nodes.
- Surgical drainage of pointed lesions speeds the healing process.
- If the lesion points at a lash follicle, removal of that one eyelash hair may promote drainage and healing.
- Exercise caution when removing a lash, because removal of multiple lashes may result in disfigurement.
Consultations
- If the patient does not respond to conservative therapy (ie, warm compresses, antibiotics) within 2-3 days, consult with an ophthalmologist.
- Consultation with an ophthalmologist is recommended prior to drainage of large lesions that may have a higher likelihood of complications.
Medication
Start therapy with a topical treatment. Progress to systemic therapy only if signs and symptoms of severe infection are found.
Antibiotics
Topical antibiotics are useful for control of staphylococcal infections in eyelids and nares.
Bacitracin ophthalmic ointment (AK-Tracin)
Prevents transfer of mucopeptides into growing cell wall; inhibits bacterial cell wall synthesis.
Adult
Severe infections: 0.25- to 0.50-in ribbon q3-4h for 7-10 d into conjunctival sac(s)
Mild-to-moderate infections: Apply bid/tid
Pediatric
Not established
None reported
Documented hypersensitivity; vaccinia; varicella; epithelial herpes simplex keratitis; mycobacterial infections; fungal diseases of the eye; patients using steroid combinations after uncomplicated removal of a corneal foreign body
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Ophthalmic ointments may delay healing of corneal epithelia; in deep seated infections of the eye, supplement with systemic medications; prolonged use may result in overgrowth of nonsusceptible organisms
Tobramycin ophthalmic solution or ointment (Tobrex, AKTob)
Interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits, which results in a defective bacterial cell membrane; available as solution, ointment, and lotion
Adult
Solution: 1-2 gtt q4h during waking hours and less frequently at night; in severe infections, instill 2 gtt q30-60min initially, followed by less frequent intervals
Ointment: Apply 0.5-inch ribbon in conjunctival sac bid/tid; in severe infections, apply q3-4h
Pediatric
<2 years: Not established
>2 years: Administer as in adults
Effects decrease when used concurrently with gentamicin
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Do not use in deep-seated ocular infections or in those that may become systemic; prolonged use of antibiotics may result in bacterial or fungal overgrowth of nonsusceptible organisms
Erythromycin (EES, E-Mycin, Ery-Tab)
First-choice treatment when systemic therapy is indicated; also indicated for treatment of infections caused by susceptible strains of microorganisms, including S aureus.
Adult
250 mg erythromycin stearate/base (or 400 mg ethylsuccinate) q6h PO 1 h ac, or 500 mg q12h
Alternatively, 333 mg PO q8h; increase to 4 g/d depending on severity of infection
Pediatric
30-50 mg/kg/d (15-25 mg/lb/d) PO divided q6-8h; double dose for severe infection
Coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin increases risk of rhabdomyolysis
Documented hypersensitivity; hepatic impairment
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI adverse effects are common (give doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur
Dicloxacillin (Dycill, Dynapen)
For treatment of infections caused by penicillinase-producing staphylococci. May be used to initiate therapy when a staphylococcal infection is suspected.
Adult
125-250 mg PO q6h
Pediatric
<40 kg: 12.5 mg/kg/d PO divided q6h
>40 kg: 125 mg PO q6h
Decreases efficacy of oral contraceptives; increases effects of anticoagulants; probenecid and disulfiram may increase penicillin levels
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Monitor PT in patients taking anticoagulant medications; toxicity may increase in patients renally impaired
Tetracycline (Sumycin)
Treats susceptible bacterial infections of both gram-positive and gram-negative organisms as well as infections caused by mycoplasmal, chlamydial, and rickettsial organisms; inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s) of susceptible bacteria
Adult
Mild-to-moderate infections: 500 mg PO bid or 250 mg PO qid for 7-14 d
Severe infections: 500 mg PO qid for 7-14 d
Pediatric
<8 years: Not recommended
>8 years: 10-20 mg/lb/d PO (25-50 mg/kg/d) divided qid
Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy; tetracyclines can increase hypoprothrombinemic effects of anticoagulants
Documented hypersensitivity; severe hepatic dysfunction
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last one half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines
Cloxacillin (Cloxapen, Tegopen)
For treatment of infections caused by penicillinase-producing staphylococci. May be used to initiate therapy when a staphylococcal infection is suspected.
Adult
250-500 mg PO q6h
Pediatric
<20 kg: 50-100 mg/kg/d PO divided q6h
>20 kg: 250 mg PO q6h
Decreases efficacy of oral contraceptives; may decrease effects of anticoagulants; probenecid and disulfiram may increase penicillin levels
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Monitor PT in patients taking anticoagulant medications; toxicity may increase in patients renally impaired
More on Hordeolum and Stye |
| Overview: Hordeolum and Stye |
| Differential Diagnoses & Workup: Hordeolum and Stye |
 Treatment & Medication: Hordeolum and Stye |
| Follow-up: Hordeolum and Stye |
| Multimedia: Hordeolum and Stye |
| References |
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References
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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
