Hordeolum Treatment & Management

Updated: Feb 12, 2021
  • Author: Michael P Ehrenhaus, MD; Chief Editor: Edsel B Ing, MD, PhD, MBA, MEd, MPH, MA, FRCSC  more...
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Medical Care

Hordeola are usually self-limited, spontaneously improving in 1-2 weeks.

Medical therapy for hordeola includes eyelid hygiene (lid scrubs), warm compresses of the lesions for 10 minutes 4 times per day, and topical antibiotic ointment in the inferior fornix if the lesion is draining or if there is an accompanying blepharoconjunctivitis. [9, 10] Nonsurgical remedies for hordeolum, although unproven, [11] do not seem to be harmful.

If an external hordeolum is centered around a lash follicle, the lash can be pulled to enhance drainage.

Systemic antibiotics may be indicated if the hordeola is complicated by preseptal cellulitis. Oral doxycycline may also be added if there is a history of multiple or recurrent lesions or if there is significant and chronic meibomitis.

Internal hordeola may occasionally evolve into chalazia, which may require topical steroids, intralesional steroids, or surgical incision and curettage. There is little to no evidence to suggest that acupuncture is beneficial. [12]


Surgical Care

Incision and drainage is indicated if the hordeolum is large or if it is refractory to medical therapy.

Incision and drainage is done under local anesthesia, and the incision is made through the skin and orbicularis (in the case of external hordeola) or through the tarsal conjunctiva and tarsus (in the case of internal hordeola). The specimen should be sent for histopathological evaluation to confirm the diagnosis and to rule out a more sinister pathology (eg, basal cell carcinoma).