Hordeolum and Stye in Emergency Medicine Treatment & Management

Updated: Aug 08, 2017
  • Author: Michael J Bessette, MD, FACEP; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
  • Print
Treatment

Emergency Department Care

Drainage of a hordeolum is performed as follows:

  • 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.

Next:

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.

Previous
Next:

Surgical Care

Chalazion is a chronic condition related to hordeola and may require surgical excision. Referral to an ophthalmologist is recommended in all cases.

Previous