Hordeolum (stye)

Hordeolum (Stye)

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Hordeolum (Stye)

Hordeolum is a common staphylococcal abscess that is characterized by a localized red, swollen, acutely tender area on the upper or lower lid. Most hordeola are external and result from obstruction and infection of an eyelash follicle and adjacent glands of Zeis or Moll glands. Follicle obstruction may be associated with blepharitis. Internal hordeolum is a meibomian gland abscess that usually points onto the conjunctival surface of the lid; external hordeolum or stye usually is smaller and on the margin.

Etiology

A stye is caused by an obstruction of a meibomian gland and/or inflammtion contributed by normal bacteria or mites (demodex) from the skin of the eyelids. Styes are similar to common acne eruptions that occur elsewhere on the skin. As there are 20-25 meibomian glands per eyelid, patients may have more than one stye at the same time. They commonly develop over a few days and may drain and heal without treatment.

Staphylococcal bacteria are the most common causes of eyelid infections, but other organisms normally found on the skin may be precipitating factors.

Hordeola are found more frequently in patients with dry eyes and chronic blepharitis (eyelid inflammation often related to demodex).

Pathophysiology

Staphylococcus aureus is the bacteria responsible for the overwhelming majority of cases of hordeolum.

An external hordeolum arises from a blockage with secondary inflammation of the Zeiss or Moll sebaceous glands of the eyelid. An internal hordeolum is a secondary inflammatory response of the meibomian glands in the tarsal plate.

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If left untreated, the chalazia may spontaneously resolve or may progress to chronic granulation with formation of a painless eyelid nodule. Chalazia may become large and can cause ptosis ( a drooping of the eyelid) with visual interference that may put pressure on and alter the shape of the cornea, leading to induced astigmatism or reduction in the superior peripheral visual field. Although rare, cellulitis of the eyelid may occur if an internal hordeolum is untreated. Most morbidity is secondary to improper drainage of the inflamed tissue.

Management

Warm compresses are helpful. Incision may be indicated if resolution does not begin within 48 hours. An antibiotic ointment (bacitracin or erythromycin) applied to the lid every 3 hours may be beneficial during the acute stage. Internal hordeolum may lead to generalized cellulitis of the lid.

Prevention

Keep eyelids and lashes clean. Remove eye makeup before going to sleep.

  • Wash your hands before touching the area around your eyes.
  • Do not share eye makeup.
  • Replace eye makeup every 3 months.
  • Keep contact lenses clean and do not over wear contact lenses.
  • If a doctor of optometry has diagnosed blepharitis, follow directions for care.
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