Hordeolums

Hordeolums, commonly known as styes, are acute purulent infections of the eyelid glands. They most often involve the glands at the eyelid margin, with external hordeolums affecting the Zeis or Moll glands and internal hordeolums affecting the meibomian glands within the tarsal plate. The majority are caused by Staphylococcus aureus.

Symptoms typically begin with a painful, red, swollen lump on the eyelid margin, often accompanied by tenderness, tearing, and sometimes purulent discharge. The lump may resemble a small pimple and can be associated with eyelid swelling or conjunctival redness. Diagnosis is usually clinical, based on the location and characteristics of the lesion. Distinguishing from a chalazion, which is usually a painless lump caused by gland blockage, is important.

Treatment focuses on symptomatic relief and limiting infection spread. Primary measures include warm compresses applied to the affected eyelid several times a day for 10 to 15 minutes, and good eyelid hygiene. Topical antibiotic ointments, such as erythromycin or bacitracin, may be used to cover the eyelid margin or in cases with conjunctival involvement. Squeezing or attempting to pop the lesion should be avoided. If the infection does not improve after 48 to 72 hours, if there is spreading redness or fever, or if an abscess forms, evaluation by an eye care professional is recommended; incision and drainage may be required for persistent or sizable internal hordeolums. Systemic antibiotics are considered only for extensive cellulitis, orbital involvement, or in individuals with immunocompromise.

Prevention focuses on eyelid hygiene and treatment of blepharitis, avoiding sharing towels or cosmetics, and seeking prompt care if symptoms worsen. Most hordeolums resolve spontaneously within one to two weeks and have a good prognosis.