Hordeolum, Causes, Symptoms, Diagnosis, Treatment

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Hordeolum is a common problem involving the eye seen in both primary and urgent care setting. It is a painful, acute infectious process of the upper or lower eyelid. Classically a hordeolum appears as a small pustule along the margin of the eyelid and can be differentiated from a chalazion which tends to involve less of an inflammatory response and follows a more chronic course.

style also known as a hordeolum is a bacterial infection of an oil gland in the eyelid.[rx] This results in a red tender bump at the edge of the eyelid.[rx]rx[rx] The outside or the inside of the eyelid can be affected.[rx]

Types of Hordeolum

There are two general categories of style

External Hordeolum

External styes emerge along the outer edge of the eyelid. They can become yellow, filled with pus, and painful when touched. They can be caused by an infection of the following:

  • Eyelash follicle – The small holes in the skin from which eyelashes grow.
  • Sebaceous (Zeis) gland –  This gland is attached to the eyelash follicle and produces sebum. Sebum helps lubricate the eyelash and stop it from drying out.
  • Apocrine (Moll) gland – This gland also helps prevent eyelashes from drying out. It is a sweat gland that empties into the eyelash follicle.

Internal Hordeolum

  • The swelling develops inside the eyelid. Generally, an internal hordeolum is more painful than an external one. They are also referred to as an internal stye and are most commonly due to an infection in the meibomian gland. These glands are responsible for producing a secretion which makes up part of the film that covers the eye.
  • Patients may also experience a burning sensation in the eye, crusting of the eyelid margins, droopiness of the eyelids, itchiness on the eyeball, sensitivity to light, tearing, a feeling that something is stuck to the eye, and discomfort when blinking.

Pathophysiology

Three different glands within the eyelid are implicated in the pathogenesis of hordeolum when they become infected by S. aureus. Infection of Zeis and Moll glands (ciliary glands) causes pain and swelling at the base of the eyelash with localized abscess formation. Termed external hordeolum, these produce the typical appearance of a stye with a localized pustule of the eyelid margin. The meibomian glands are modified sebaceous glands that are found in the tarsal plate of the eyelids. They produce an oily layer on the surface of the eye that helps to maintain proper lubrication of the eye. When a meibomian gland becomes acutely infected, it results in an internal hordeolum. Due to its deeper position within the eyelid, internal hordeola have a less defined appearance than external hordeolum. Chalazia occur secondary to mechanical obstruction and dysfunction of the meibomian gland with subsequent stasis and blockage of the release of sebum. This condition tends to be subacute to chronic and presents with a painless nodule within the eyelid or at the lid margin.

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Cause of Hordeolum

Styes are most commonly caused by the blocking of an oil gland at the base of the eyelash. Styes are experienced by people of all ages.

  • Styes can be triggered by poor nutrition, sleep deprivation, lack of hygiene, lack of water, and rubbing of the eyes. Styes often result from a Staphylococcal infection in the eye and can be secondary to blepharitis or a deficiency in immunoglobulin.[rx]
  • Sharing of washcloths or face towels should be curtailed to avoid spreading the infection between individuals.[rx][rx]

Symptoms of Hordeolum

The first sign of a stye is a small, yellowish spot at the center of the bump that develops as pus and expands in the area.[rx] Other stye symptoms may include

  • A lump on the top or bottom eyelid
  • Localized swelling of the eyelid
  • Swelling of the eyelid
  • Localized pain
  • Redness
  • Tenderness
  • Crusting of the eyelid margins
  • Burning in the eye
  • Droopiness of the eyelid
  • The scratchy sensation on the eyeball (itching)
  • Blurred vision
  • Mucous discharge in the eye
  • Irritation of the eye[8]
  • Light sensitivity
  • Tearing
  • Discomfort during blinking[9]
  • The sensation of a foreign body in the eye
  • Burning sensation
  • The droopiness of the eyelid
  • Itching of the eye
  • Discharge of mucus from the eye
  • Light sensitivity
  • Discomfort when blinking
  • The feeling that there is an object in the eye

Diagnosis of Hordeolum

History and Physical

A careful history of and physical exam is essential.

  • The patient will usually relay a slow and insidious onset of a painful, red, and swollen eyelid without a history of foreign body or trauma.
  • Visual acuity may be affected if the size of the hordeolum is pressing on the cornea. The patient should not report ocular pain, and their extraocular movements should be intact and painless. The erythema is localized to the lid of the affected eye.
  • The provider should try to locate a pustule, and the eyelids may need to be everted, especially to locate an internal hordeolum. The provider should inquire about any of the predisposing conditions for hordeolum, and these conditions should be addressed and managed in treatment.
  • Any pain in ocular movements with periorbital swelling and erythema is indicative of orbital cellulitis and requires additional and more aggressive management and treatment. Persistent or recurrent painful lumps in the eye may be indicative of carcinoma and require biopsy. Ophthalmology referral is indicated in these situations.   

Treatment of Hordeolum

  • Apply a warm washcloth to the eyelid. Apply for 10 to 15 minutes at a time, 3 to 5 times a day. Rewarm washcloth as needed by soaking it in warm water. Wring out excess water, then reapply to the eyelid.
  • Gently wipe away eyelid drainage with mild soap such as Johnson’s baby shampoo and water, or eyelid wipes (available in drug stores).
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Also, follow these tips

  • Do not squeeze or pop a sty.
  • Do not rub or touch your eyelid.
  • Do not wear makeup or contact lenses until the area has fully healed.

A sty that does not improve within 48 hours of self-care may require medical treatment by a doctor. Treatments given by doctors include:

  • In-office incision (under local anesthesia) to drain the sty
  • Antibiotic ointment to apply to the eyelid or antibiotic eye drops. Sometimes antibiotic pills are prescribed if there is an infection of the area surrounding the eye or after incision and drainage of an internal sty.
  • Steroid injection into the sty to reduce the swelling in the eyelid

Stye Treatment Keep Your Eyelids Clean

  • Cleanse your eyelids – The first thing you should do if you develop a stye is cleansing your eyelids. You can use diluted tear-free baby shampoo on a cotton ball, washcloth, or makeup remover pad. Then rinse your eyelids with warm water and gently pat them dry.
  • Wash your hands – Also, be sure to wash your hands before and after touching the stye, and don’t share your towels or washcloths with others.
  • Use a cleansing pad –  Pre-moistened eyelid cleansing pads are another option. You can find these non-prescription items in most drugstores.
  • Pause your makeup use – It’s wise to stop wearing eye makeup temporarily when you have a stye, because covering up a stye can delay the healing process. Also, discard old makeup or applicators that could be contaminated.
  • Wear your glasses, not contacts, for a bit – And if you need vision correction, wear glasses rather than contact lenses until your stye heals.

Apply Warm, Moist Compresses

  • Apply warm compresses – You can speed the healing of a stye by applying warm compresses for 10 to 15 minutes, three or four times a day.
  • Try a teabag or washcloth – Some people use teabags for this purpose, but a basic clean washcloth dipped in warm (not hot) water will do the trick and is easy to prepare. Wring the cloth so it’s not dripping, then place it over your closed eyes.
  • Don’t pop a stye – The goal of this therapy is to bring the stye to a head like you see on a pimple. But whatever you do, don’t get anxious and try to pop a stye! The warmth from the compress often will allow the stye to open, drain and heal on its own without causing trauma to the eyelid or possibly spreading infection by squeezing it.

Ease The Discomfort

  • Painkillers – Over-the-counter painkillers like acetaminophen and ibuprofen probably won’t do much to speed healing, but these medications may ease discomfort if a stye is particularly bothersome.
  • Eye surgery – Your eye doctor also can address pain associated with styes. Sometimes, your eye doctor may choose to surgically open a large stye to relieve discomfort and prevent a serious infection.
  • Antibiotics – can be administered locally at the site of infection or may be given systemically. Most cases of hordeolum are caused by a staphylococcal species; therefore antibiotics should be effective against the bacteria. Application of topical antibiotics may reduce healing time by fighting against the causative bacterial infection and reducing inflammation. Many topical medications include ingredients that relieve the symptomatic pain of internal hordeolum. Antibiotics can also be applied locally by injection. Systemic antibiotics are sometimes used when local antibiotics are not effective, or when the infection is not localized.
  • Steroids – can be applied topically as ointments or eyedrops. Internal hordeolum has a short course; therefore as little as one steroid treatment could be effective in reducing healing time and relieving symptoms associated with the inflammation [.
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Home Treatment

Most styes go away on their own in five to seven days with home remedies.

  • Apply warm compresses –  four to six times a day for about 15 minutes at a time to help the stye to drain. Keep the eyes closed when applying the warm compresses.
  • Gently scrub – the eyelid with tap water or with a mild, nonirritating soap, or shampoo (such as baby shampoo). This may help with drainage. Close the eyes as you scrub so you do not injure your eyes.
  • Do not squeeze or puncture the stye –  A more serious infection may occur as a result.
  • Discontinue – the use of eye makeup as well as eye lotions and creams because bacteria from the infection may contaminate them.
  • Discontinue wearing contact lenses – while a stye is present because the infection may cause an infection to spread to the cornea with the use of contact lenses.
  • Leave the sty alone – Don’t try to pop the sty or squeeze the pus from a sty. Doing so can cause the infection to spread. 
  • Place a warm washcloth over your closed eye – To relieve pain, run warm water over a clean washcloth. Wring out the washcloth and place it over your closed eye. Re-wet the washcloth when it loses heat. Continue this for 5 to 10 minutes. Then gently massage the eyelid. Repeating this two to three times a day may encourage the sty to drain on its own.
  • Keep your eye clean – Don’t wear eye makeup until the sty has healed.
  • Go without contacts lenses – Contact lenses can be contaminated with bacteria associated with a sty. If you wear contacts, try to go without them until your sty goes away.


References

Hordeolum

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