Hordeolum and Stye in Emergency Medicine Treatment & Management

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

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.[1]
    • 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.
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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.
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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 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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