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Subject: Hordeolum (Stye)
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An acute inflammation or infection of the eyelid margin involving the sebaceous gland of an eyelash (external hordeolum) or a meibomian gland (internal hordeolum)
System(s) affected: skin/exocrine
Synonym(s): internal hordeolum; external hordeolum; Zeisian stye; meibomian stye; stye
Predominant age: none
Predominant sex: male = female
Bacterial infection of sebaceous or meibomian glands, causing an acute inflammatory reaction
In an internal hordeolum, the meibomian gland may become obstructed, leading to a pustule on the conjunctival surface as opposed to the margin of the eyelid.
Most commonly caused by Staphylococcus aureus (∽90-95% of all cases) or by Staphylococcus epidermidis
Seborrhea can predispose to infections of the eyelid.
Poor eyelid hygiene
Contact lens wearers
Application of makeup
Predisposing blepharitis (low-grade infections of the eyelid margin)
An association may exist between hordeolum during childhood and developing rosacea in adulthood.
Localized inflammation (vs. involvement of the entire eyelid or surrounding skin)
Foreign body sensation in the eye
Prior episodes are common.
Localized inflammation of the eyelashes or a small pustule at the margin of the eyelid
Localized swelling and tenderness on the internal or external aspect of the eyelid with an opening to either side
To determine if an internal hordeolum is obstructed, the eyelid should be gently everted to examine for a pustule on the tarsal conjunctiva.
Itching or scaling of the eyelids; collection of discharge, redness, and irritation leading to localized tenderness and pain
The size of the swelling usually correlates to the severity of the hordeolum.
The hordeolum should not be expressed.
Warm compresses to the area of inflammation can help increase blood supply and encourage spontaneous drainage.
Good personal hygiene with attention to cleansing the eyelids on a daily basis helps to prevent recurrent infections.
A Cochrane review found no evidence for or against nonsurgical treatment of internal hordeolum. External hordeola were not considered 1[A].
Usually, a hordeolum spontaneously drains, aided by warm compresses to the area.
Also, lid scrubs, digital massage, and alternative medicine have been used to reduce healing time and relieving symptoms.
Application of an antibiotic ointment (e.g., erythromycin ) to the margin of the eyelid after proper cleansing (except in children age ≪12 years, in whom there is a risk of blurred vision and amblyopia) helps reduce bacterial proliferation. There is little evidence that any topical therapy is effective. Erythromycin ophthalmic ointment may be applied up to 6 times per day for 7 to 10 days or an antibiotic ointment containing bacitracin 2,3[C].
Treat underlying dry eye with artificial tears.
Occasionally, the use of an aminoglycoside ophthalmic ointment, such as gentamicin or tobramycin, may be necessary if condition is refractory to simpler treatment (case reports).
Oral dicloxacillin or cephalexin for 2 weeks if refractory to topical antibiotics
If the infection becomes localized to a single gland, incision, drainage, or curettage sometimes is necessary. This is an in-office procedure with a local anesthetic: Exercise caution because ocular perforation has been reported with the injection of an anesthetic to an infected lid.
Use of combined antibiotic ointment (neomycin sulfate, polymyxin B sulfate, and gramicidin) after surgery was not shown to have any statistically significant benefit compared with artificial tears.
The patient should be instructed in proper cleansing of the eyelids using a solution of tap water and baby shampoo or a commercially prepared hypoallergenic cleanser.
The stye should not be squeezed or incised.
Usually responds well to good hygiene and warm compresses
Inflammation usually improves within a week.
Hordeolum tends to recur in some patients, usually due to incomplete elimination of bacteria.
Bamford JT, Gessert CE, Renier CM, et al. Childhood stye and adult rosacea. J Am Acad Dermatol. 2006;55(6):951–955.
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. 2005;88(5):647–650.
Kim JH, Yang SM, Kim HM, et al. Inadvertent ocular perforation during lid anesthesia for hordeolum removal. Korean J Ophthalmol. 2006;20(3):199–200.
Nakatani M. Treatment of recurrent hordeolum with Broncasma Berna. Eye (Lond). 1999;13(Pt 5):692.
Wald ER. Periorbital and orbital infections. Infect Dis Clin North Am. 2007;21(2):393–408, vi.
H00.019 Hordeolum externum unspecified eye, unspecified eyelid
H00.029 Hordeolum internum unspecified eye, unspecified eyelid
H00.039 Abscess of eyelid unspecified eye, unspecified eyelid
H00.013 Hordeolum externum right eye, unspecified eyelid
H00.024 Hordeolum internum left upper eyelid
H00.016 Hordeolum externum left eye, unspecified eyelid
H00.011 Hordeolum externum right upper eyelid
H00.012 Hordeolum externum right lower eyelid
H00.036 Abscess of eyelid left eye, unspecified eyelid
H00.022 Hordeolum internum right lower eyelid
H00.033 Abscess of eyelid right eye, unspecified eyelid
H00.015 Hordeolum externum left lower eyelid
H00.026 Hordeolum internum left eye, unspecified eyelid
H00.031 Abscess of right upper eyelid
H00.023 Hordeolum internum right eye, unspecified eyelid
H00.032 Abscess of right lower eyelid
H00.035 Abscess of left lower eyelid
H00.034 Abscess of left upper eyelid
H00.014 Hordeolum externum left upper eyelid
H00.021 Hordeolum internum right upper eyelid
H00.025 Hordeolum internum left lower eyelid
373.11 Hordeolum externum
373.12 Hordeolum internum
373.13 Abscess of eyelid
397513003 Hordeolum (disorder)
1489008 hordeolum externum (disorder)
414521009 internal hordeolum (disorder)
76126009 Abscess of eyelid
700367002 Hordeolum externum of lower eyelid (disorder)
700368007 Internal hordeolum of lower eyelid (disorder)
700286007 Hordeolum externum of upper eyelid (disorder)
700366006 Internal hordeolum of upper eyelid (disorder)
A hordeolum should not be expressed.
Warm compresses to the area of inflammation can encourage spontaneous drainage.
Application of an antibiotic ointment (e.g., erythromycin ) to the margin of the eyelid after proper cleansing helps reduce bacterial proliferation but may have no effect on the healing of the stye.
Good personal hygiene with attention to cleansing the eyelids on a daily basis can prevent recurrent infections.