Hordeolum Clinical Presentation

Updated: Sep 27, 2017
  • Author: Michael P Ehrenhaus, MD; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Presentation

History

Hordeola essentially represent focal abscesses; therefore, they will present with features of acute inflammation, such as a painful, warm, swollen, red lump on the eyelid.

The eyelid lump may also induce corneal astigmatism and cause blurring of vision.

The patient often has a past history of similar eyelid lesions or risk factors for hordeola, such as meibomian gland dysfunction, blepharitis, or rosacea. [6]

Clinically differentiating hordeola from acute chalazia may be difficult, because they both present with acute inflammation and tender eyelid lumps. However, chronic chalazia represent a granulomatous reaction and, thus, appear firm and nontender on clinical examination. [4]

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Physical

On examination, a tender erythematous subcutaneous nodule is present near the eyelid margin, which may undergo spontaneous rupture and drainage. If sufficient edema is present, then it may be difficult to palpate a discrete nodule. These nodules may be unilateral or bilateral, single or multiple.

The inflammation associated with hordeola may spread to adjacent tissue and cause a secondary preseptal cellulitis.

Patients may also have signs of meibomitis, blepharitis, or ocular rosacea. [6]

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Causes

Hordeola are associated with S aureus infection. [3]

Patients with chronic blepharitis, meibomian gland dysfunction, and ocular rosacea are at greater risk of developing hordeola than the general population. [6]

There are published case reports where multiple recurrent hordeola have been associated with selective immunoglobulin M (IgM) deficiency. [7]

The lipid component of chalazia has been found to have large cholesterol content and is dissimilar to the lipid found in meibomian glands. Studies have reported an association between multiple chalazia and elevated serum cholesterol levels. Some studies have even suggested that elevated serum lipid levels may increase the risk of blockage to oil glands of the eyelids and, therefore, predispose to hordeola and chalazia.

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