Hordeolum
A hordeolum occurs when the bacteria are infected with the infection and produces pain, swelling or redness.
Hordeolums are lumpy lumps that form around the eyelids.
The therapy includes cold compresses with antibiotic eye drops or ointments.
Hordeola is preventable through eyelid cleaning at night, avoiding eye makeup and changing eye makeup every three months.
Avoid using the suction cups.
Call your eye doctor as soon as you have a lump enlarged in the eye.
Introduction
Hordealum is a bacterial infection found on the eyelids.
These infections are commonly encountered and typically require evaluation and treatment by a primary care physician or acute care facility.
Generally the patient is experiencing pain and erythema swelling in the eyelids.
The hordeolum forms at the outer eyelid and is often called stye.
The eyelids are also often formed in this way which is easily misidentified as chalazion or stye.
The symptoms often last from 2 – 4 months, are limited by nature and sometimes resolve themselves.
It can also have cold compresses or massages if needed.
Signs of hordeolum
External hordea Lump tender inflammation in the lids.
Often multiple abscesses can be seen within eyelids
Internal hordeolum is a tender swelling of tarsoplate – the most painful thing.
Pathophysiology
The infection occurs when a zeis molecular gland or Meibomian gland has thickened, dried or stasis, resulting in an inflammatory response.
Normally the zeis glands secrete sebum to reduce bacterial apoptosis.
The moll glands produce immunoglobulin A, mucin, and Lysosomes which play an important role when protecting the eye from bacteria and infections.
During clogging and blockage the glands the eyes’ defenses suffer greatly.
Stasis can cause infection by bacteria with staphylococcus aureus a common pathogenesis.
Risk factors
You are more likely to get a stye if you:
- Have had one before
- Wear contact lenses
- Are not keeping your eye area clean
- Use eye makeup that is old or contaminated
- Have other eye conditions such as an inflamed or infected eyelid (blepharitis-a chronic inflammation along the edge of the eyelid )
- Have other conditions such as rosacea, seborrheic dermatitis, or diabetes
Aetiology
An inflammatory scab and inflammation of the eyelids.
This infection usually involves sporadic infection.
Repeated incidents occur frequently.
The internal hordeolum may develop problems.
Sebaceous gland
This gland is attached to the eyelash follicle and produces an oily substance called sebum, which lubricates the eyelashes to prevent them from drying out.
Apocrine gland
This sweat gland is attached to the eyelash follicle and helps keep the eye from becoming too dry.
Etiology
It occurs most commonly in a case of staphylococcus that attacks eyelashes and hair cells.
The hordeolum external causes an obstruction in the sebacystin and sweat glands or moll glands.
The obstruction occurs along the eyelash lines and is characterized by painful red swelling and turns into pustules on the skin.
In the internal hordeolum there is an obstruction in the Meibomian gland, and the pustule forms inside the eyelid.
Hordeola can be found under the eyelids, as well as the upper eyelids.
External hordeolum
An external eyelid stye is a red, painful bump on the surface of the eyelid.
The bump may resemble a pimple and be tender to the touch.
External hordeolum (stye) – acute bacterial infection of the lash follicle and its associated gland of Zeis or Moll.
Tender inflamed swelling of the lid margin.
May point anteriorly through the skin.
Occasionally, multiple abscesses involve entire eyelid.
After 1 to 2 days, an external hordeolum localizes to the eyelid margin.
There may be tearing, photophobia, and a foreign body sensation.
Typically, a small yellowish pustule develops at the base of an eyelash, surrounded by hyperemia, induration, and diffuse edema.
Within 2 to 4 days, the lesion ruptures and discharges material (often pus), thereby relieving pain.
In the case of external hordeola, it may help to remove the lash associated with the infected follicle.
Although these symptoms are associated with external styes, they can also be indicative of other eye infections.
It’s important to contact your eye doctor as soon as possible to receive a proper diagnosis.
Internal hordeolum
Internal hordeolum – acute bacterial infection of Meibomian gland.
Tender inflamed swelling within the tarsal plate.
More painful than a stye.
May point anteriorly through the skin or posteriorly through the conjunctiva.
If the hordeolum lies near the inner canthus of the lower eyelid, it must be differentiated from dacryocystitis.
Epidemiology
Hordeolum is commonly present in family practices or specialized health facilities.
It has been found that races, genders and sexuality correlate in hordeolum incidences.
Adults have higher levels of sensitivity as their skin becomes more porous.
Patients with conditions like seborrheic dermatitis and hyperlipidemia can also become vulnerable to hordeola.
Evaluation
Normally hordeolum has no diagnostic tests that are clinical in nature.
Rarely additional tests may need to be performed to diagnose complications and spread and cause orbital or periorbital cellulitis.
Occasionally, an inner hordealum may cause corneal irritation, which may require the use of fluorescein for removing corneal abrasion.
History and Physical
A thorough historical examination is crucial.
The patient typically presents an infrequently but slowly painful and red swollen eyelid.
Visibility may decrease when the diameter of the hordeolum touches the cornea.
Patients should never experience ophthalmic discomfort and the extraocular movements should remain unchanged and pain free.
The erythema occurs on the lid of the damaged eye.
Often a patient’s eyelid is needed for the insertion or removal of the pustule.
Differential diagnosis
- Malignant or benign tumors such as:
- sebaceous carcinoma or sebaceous hyperplasia;
- less commonly juvenile xanthogranuloma,
- basal cell,
- seborrheic keratosis,
- epithelial inclusion cyst o
- a retained foreign body can appear similar to a chalazion.
Treatment / Management
How is a stye treated?
In most cases a stye will go away on its own.
There are some things you can do to treat the stye at home.
These include:
- Putting a warm, wet cloth (compress) on your eyelid for 5 to 10 minutes. This should be done 3 to 5 times a day.
- Washing your hands often
- Washing your face daily
In some instances, lesions may spontaneously drain without treatment.
Warm compresses and massages help to relax. They are often considered gold standards.
Warm compressions help to soften granulomatous tissues and promote drainage.
There is not yet evidence proving that this technique alone causes shortened lengths or improved outcomes.
Lid massages are intended for expressing the purulent drainage in an infected gland.
Lid scrubs using saline and mild shampoos that are tearless and pH balanced may promote drainage by clearing debris from the blocked ducts.
Keep contact lenses clean and do not over wear contact lenses.
Treatment includes warm compresses and antibiotic eye drops or ointments.
Pharmacological
Systemic antibiotics are sometimes used when local antibiotics are not effective or when the infection is not localized.
Systemic antibiotics (eg, dicloxacillin or erythromycin 250 mg orally 4 times a day) are indicated.
Management by eye doctor
Eye doctor must identify their limits and, if required, seek further guidance or refer patients elsewhere.
Continuing education activities
Hordeolum infections occur in eyes, which frequently occur with hordes and other bacterial infections.
Patients with these conditions often report inflammation on the eyelids and face to the eye doctor.
This activities reflect the evaluation of Hostersolum and reviews its role in patient management.
Descriptions of typical medical presentations and hordeolums.
Describe hordeolum pathology and disease.
Summarize using hot compress and lid-massing solution for hordeolum.
Pearls and other issues
While hordeolum appears as a common manifestation an eye doctor must ensure there have been other symptoms of painful red eyelids.
Other diagnostic criteria which can be considered include periorbital orbital cellulitis and chalazaion.
The provider must look beyond symptoms such as blepharitis or acne.
This condition is needed to prevent the recurrent hordeolum in the patient.
Chalazion may mimic an internal hordeolum, so it might be a bit hard to differentiate them.
Enhancing healthcare team outcomes
Hordeolum may also be encountered by a primary care professional in a hospital setting.
The infection is usually treated using conservative treatments.
Warm compresses are designed to soften and facilitate fluid drainage.
Persistent or more pronounced lesions need medical attention.
It could also decrease symptoms of depression in the elderly.
In some cases, the patient should be sent into a hospital with a stout ophthalmologist who can diagnose the condition.
Ophthalmologists make incisions and drains in an aesthetically pleasing environment.
Ideally, the specimens will go to pathologists for diagnostics aimed at detecting more serious ailments.
References
Acute abscess within an eyelid sebaceous gland. (https://pubmed.ncbi.nlm.nih.gov/27168505/) Clev Clin J Med . 2016 May; 83(5):332-334.
Review Interventions for acute internal hordeolum. Lindsley K, Nichols JJ, Dickersin K. Cochrane Database Syst Rev. 2010 Sep 8; (9):CD007742.
Review Interventions for acute internal hordeolum. [Cochrane Database Syst Rev. 2013
