SIGNS AND SYMPTOMS 
- Hordeolum:
- Develops acutely when glandular outflow is obstructed
- Red, tender, painful, swollen mass along the eyelid margin
- Typically solitary, rarely may be multiple
- May be recurrent
- Well-localized inflammation
- Presentation depends on which gland is affected:
- External hordeolum (stye):
- Originates from obstruction of the superficial sebaceous or sweat glands whose ducts are located between the eye lashes
- Exquisitely tender small mass that typically points anteriorly
- Internal hordeolum:
- Originates from obstruction of the sebaceous glands whose ducts are located on the inner aspect of the lid margin
- Painful small mass that is palpable through the eyelid
- May cause a foreign body sensation in the eye and visual disturbance
- Typically more inflamed, larger, and more painful
- May point internally or through skin
- Nonsystemic process
- May be complicated by:
- Chalazion:
- Firm, circumscribed, nontender, or minimally tender nodule:
- Noninflamed
- Symptoms most commonly owing to physical properties:
- Disrupts natural contour of eye
- Obstructs visual field/peripheral vision
- Pressure on globe
- Corneal desiccation or injury due to exposure
- Nonacute, nonemergent process, which requires no urgent or emergent intervention unless secondary corneal or significant globe pressure is present.
History
Hordeolum—sudden, well localized, painful mass along the margin of eyelid:
Physical Exam
Focal, tender, inflammation of an external or internal gland of the eyelid:
- Minimal surrounding edema may be seen
- Abscess may point within lash line, from palpebral conjunctiva or externally via skin of the lid
ESSENTIAL WORKUP
- Complete ophthalmologic exam including slit lamp exam and corneal evaluation
- Evaluation for evidence of associated cellulitis and/or systemic findings
- Hordeolum:
- Identify the origin of the abscess
- Chalazion:
- Determine whether physical properties of chalazion result in corneal exposure and injury.
DIAGNOSIS TESTS & INTERPRETATION
Lab
Cultures of any drainage rarely aids in management
DIFFERENTIAL DIAGNOSIS
[Outline]
ED TREATMENT/PROCEDURES
- Hordeolum—relieve obstruction and prevent abscess formation
- Warm compresses for 15 min 4–6 times per day
- Gently massage the nodule to express obstructed material
- Rarely, in severe cases, incision and drainage of internal hordeolum may be necessary:
- Typically done by ophthalmologist
- If pointed toward the conjunctiva, vertical incision is made to avoid injury to the meibomian glands and reduce corneal injury from inadvertent scarring.
- External skin incision is very rarely indicated.
- When necessary, horizontal incision is used
- Removing single involved eyelash may be helpful in rare more severe cases of external hordeolum
- Botox
- Chalazion—complaints typically reflect nonemergent aesthetic and cumbersome physical properties of the mass:
- Referral to ophthalmology for incision and curettage or steroid injection
- Lubricating eye drops may provide symptomatic relief
MEDICATION
Ophthalmologic moisturizing drops as needed for comfort.
[Outline]
DISPOSITION
Discharge Criteria
No indication for admission unless secondary complication is present (i.e., marked periorbital cellulitis with systemic symptoms)
Issues for Referral
- Urgent consultation with ophthalmologist should be considered if incision and drainage of internal hordeolum is deemed indicated.
- Chalazia should be referred to ophthalmologist for definitive treatment options.
FOLLOW-UP RECOMMENDATIONS
- Follow-up with ophthalmology in 1–2 days to evaluate response to conservative management.
- Symptoms should complete resolve in 1–2 wk
[Outline]
- Cronau, Kankanala RR, Mauger T. Diagnosis and management of red eye in primary care. Am Fam Physician. 2010;81(2):137–144.
- Goawalla A, Lee V. A prospective randomized treatment study comparing three treatment options for chalazia: Triamcinolone acetonide injections, incision and curettage and treatment with hot compresses. Clin Exp Ophthalmol. 2007;35:706–712.
- Gomi CF, Granet DB. Common conditions affecting the internal eye. Pediatric Ophthalmol. 2009;449–459.
- Lindsley K, Nichols JJ, Dickersin K. Interventions for acute internal hordeolum Cochrane Database Syst Rev. 2010;(9):CD007742.
- Zvandasara T, Diaper C. Tips for managing Chalazion InnovAiT: The RCGP. J Assoc Train. 2012;5:133–136.
See Also (Topic, Algorithm, Electronic Media Element)