A hordeolum is a suppurative infection of one of the eyelid glands.1-15 The nomenclature that describes infectious and inflammatory conditions of the eyelid glands is at times confusing. A brief description of the eyelid margin anatomy may help resolve some of the confusion. The patient usually presents with an acutely painful, erythematous, localized, and tender mass on either the upper or lower eyelid. A hordeolum may be associated with a blepharitis.
ANATOMY AND PATHOPHYSIOLOGY
The eyelid is composed of numerous structures (Figure 196-1). The eyelid skin is thin and vascular. The orbicularis oculi muscle encircles the eyelids and controls their movements. The hair follicles that form the eyelashes are fine and delicate in comparison to hair on other body areas. Numerous glands are contained within the eyelids. The glands of Zeis are modified sebaceous glands associated with the hair follicles. The glands of Moll are modified sweat glands that open into the base of the hair follicles. The tarsus is a rigid fibrous plate containing the sebaceous Meibomian glands. The orifice of the elongated Meibomian glands can be seen posterior to the eyelashes at the eyelid margin. The thin and delicate conjunctiva lines the inner aspect of the eyelids.
Eyelid margin anatomy. The type and location of the infected gland determines whether it is an internal hordeolum or an external hordeolum (stye).
A hordeolum can be located internally or externally in relation to the eyelid and tarsal plate. It is essentially an abscess of the eyelid. An internal hordeolum is a bacterial infection of the Meibomian gland and usually points to the inside or conjunctiva (Figure 196-2). An internal hordeolum is usually larger than an external hordeolum. If the infection blocks the neck of the Meibomian gland, the infection points toward the conjunctival surface of the eyelid. If the neck of the Meibomian gland is not blocked, the infection often points to the eyelid margin. An external hordeolum, also known as a stye, is a bacterial infection of the glands of Zeis or Moll. These tend to be small, superficial, and point to the eyelid skin or, more commonly, the eyelid margin. The most common causative agent in both internal and external hordeola is Staphylococcus aureus.1 Other infectious agents and conditions can be the etiology.15
An internal hordeolum with redness and swelling.
Patients with a hordeolum almost always present with localized pain, redness, and swelling of the eyelid margin. It is usually a benign process but can progress to a preseptal or septal cellulitis. It may rarely result in a corneal epithelial defect,2 periorbital necrotizing fasciitis,3 and bacteremia.4