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Clinical Summary

A hordeolum is a localized abscess involving the glands of the eyelid. An external hordeolum (stye) involves an eyelash (cilia) follicle or the tear glands of the lid margin (glands of Zeis, Moll). An internal hordeolum involves the meibomian glands. S aureus is the most frequent isolate, although hordeola may be sterile. Clinical findings include focal swelling, edema, erythema, and tenderness.

A chalazion is a chronic localized inflammation that results from the obstruction of the meibomian glands. It may arise from a hordeolum. The lesion may point anteriorly (toward the skin of the eyelid) or posteriorly (toward the tarsal conjunctiva). It may become sufficiently large as to press on the globe and cause astigmatism. Pain and redness may be seen early in the course, but these may dissipate over time.

Management and Disposition

Hordeola can be treated with warm compresses. The clinical course of a hordeolum is usually self-limited, with spontaneous drainage and resolution in 5 to 7 days. Topical antibiotics are not helpful. Systemic antibiotics are unnecessary unless there is concurrent preseptal cellulitis. If the mass persists or is large (distorting vision), ophthalmology referral is recommended for incision and curettage or intralesional corticosteroid injection.

Frequent warm compresses applied to chalazia expedite spontaneous drainage. Most chalazia spontaneously clear after several weeks. Antibiotics are not indicated since chalazia result from a granulomatous process. Recalcitrant lesions should be referred to the ophthalmologist for incision and curettage or glucocorticoid injection.

Pearls

  1. Uncomplicated hordeola and chalazia can be treated with warm compresses and generally resolve spontaneously.

  2. Patients with rosacea or marginal blepharitis (a chronic low-grade inflammation of the lid margins with crusts around the lashes) have frequent hordeola.

  3. Older patients with recurrent chalazia should be referred to the ophthalmologist to rule out malignancy.

FIGURE 2.28

Eyelid Anatomy. Anatomic structures related to eyelid pathology.

FIGURE 2.29

Hordeolum. Focal swelling and erythema at the lid margin are seen in this hordeolum. (Photo contributor: Frank Birinyi, MD.)

FIGURE 2.30

Chalazion. This chalazion shows painful nodular focal swelling and erythema from meibomian cyst formation. (Photo contributor: Frank Birinyi, MD.)

FIGURE 2.31

Chalazion. Two months of focal pain and swelling of the lateral upper lid. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 2.32

Chalazion. A nontender bipartite chalazion is shown. (Photo contributor: Kevin J. Knoop, MD, MS.)

FIGURE 2.33

Blepharitis. The eyelid margins are inflamed and erythematous. (Photo contributor: Kevin J. Knoop, MD, ...

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