section name header

Basic Information ⬇

AUTHOR: Glenn G. Fort, MD, MPH

Definition

A hordeolum is an acute inflammatory process affecting the eyelid and arising from the meibomian (posterior) or Zeis (anterior) glands. It is most often infectious and usually caused by Staphylococcus aureus. When infection involves the meibomian glands, it is called meibomianitis.

Synonyms

Hordeolum

Meibomianitis

ICD-10CM CODES
H00.011Hordeolum externum right upper eyelid
H00.012Hordeolum externum right lower eyelid
H00.013Hordeolum externum right eye, unspecified eyelid
H00.014Hordeolum externum left upper eyelid
H00.015Hordeolum externum left lower eyelid
H00.016Hordeolum externum left eye, unspecified eyelid
H00.019Hordeolum externum unspecified eye, unspecified eyelid
H00.021Hordeolum internum right upper eyelid
H00.022Hordeolum internum right lower eyelid
H00.023Hordeolum internum right eye, unspecified eyelid
H00.024Hordeolum internum left upper eyelid
H00.025Hordeolum internum left lower eyelid
H00.026Hordeolum internum left eye, unspecified eyelid
H00.029Hordeolum internum unspecified eye, unspecified eyelid
Epidemiology & Demographics
Incidence (in U.S.)

Unknown

Prevalence (in U.S.)

Unknown

Predominant Sex

No gender predilection

Predominant Age

May occur at any age

Peak Incidence

May occur at any age

Neonatal Infection

Rare in the neonatal period

Physical Findings & Clinical Presentation

  • Abrupt onset with pain and erythema of the eyelid
  • Localized, tender mass in the eyelid (Fig. E1)
  • May be associated with blepharitis
  • External hordeolum: Points toward the skin surface of the lid and may spontaneously drain
  • Internal hordeolum: Can point toward the conjunctival side of the lid and may cause conjunctival inflammation

Figure E1 External hordeolum (stye).

From Bowling B: Kanski’s clinical ophthalmology: a systemic approach, ed 8, Philadelphia, 2016, Elsevier.

Etiology

  • 75% to 95% of cases are caused by S. aureus, which includes methicillin-resistant S. aureus (MRSA) strains.
  • Occasional cases are caused by Streptococcus pneumoniae, other streptococci, gram-negative enteric organisms, or mixed bacterial flora.

Diagnosis ⬆ ⬇

Differential Diagnosis

  • Eyelid abscess
  • Chalazion
  • Allergy or contact dermatitis with conjunctival edema
  • Acute dacryocystitis
  • Herpes simplex infection
  • Cellulitis of the eyelid
Laboratory Tests

  • Generally, none are necessary.
  • If incision and drainage are performed, specimens should be sent for bacterial culture.

Treatment ⬆ ⬇

Nonpharmacologic Therapy

External stye (eyelash follicle): Usually responds to warm compresses and will drain spontaneously.

Acute General Rx

  • Systemic antibiotics generally not necessary for an external stye.
  • For internal stye, use hot packs plus oral dicloxacillin 500 mg qid × 7 days. If suspecting MRSA, use trimethoprim-sulfamethoxazole DS bid in place of dicloxacillin. In patients with hospital-acquired infection, consider linezolid 600 mg PO bid.
  • For external stye, topical erythromycin ophthalmic ointment applied to the lid margins two to four times daily until resolution may be helpful in some cases.
  • Incision and drainage: Rarely needed but should be considered for progressive infections.
Disposition

  • Usually sporadic occurrence
  • Possible relapse if resolution is not complete
Referral

  • For evaluation by an ophthalmologist if visual acuity or ocular movement is affected or if the diagnosis is in doubt
  • For surgical drainage if necessary

Pearls & Considerations ⬆ ⬇

Comments

Seborrheic dermatitis may coexist with hordeolum.

Related Content

Chalazion (Patient Information)

Stye (Hordeolum) (Patient Information)

Suggested Readings ⬆

  1. Deibel J.P., Cowling K. : Ocular inflammation and infectionEmerg Med Clin North Am. ;31(2):387-397, 2013.
  2. Lindsley K. : Interventions for acute internal hordeolumCochrane Database Syst Rev. ;4, 2013.
  3. McAlinden C. : Hordeolum: acute abscess within an eyelid sebaceous glandCleve Clin J Med. ;83:332-334, 2016.