Acute bacterial infection of eyelids.
Classification
Hordeolum externum “stye”
Localized abscess formation of the follicle of an eyelash
- Caused by blockage of sebaceous (Zeis) glands or sweat (Moll) glands at the lash line and presents as a painful red swollen area that develops into a pustule.
Hordeolum internum
Acute bacterial infection of the meibomian glands of the eyelid
- Caused by blockage of Meibomian glands, and the pustule forms on the inner surface of the eyelids.
Aetiology
Causative organisms:
- Staphylococcus aureus (M/C, 90-95% cases)
- Staphylococcus epidermidis (#2 M/C)
Risk factors:
These conditions have an increased risk for the development of hordeola
- Blepharitis
- Seborrheic dermatitis
- Rosacea
- Diabetes
- Elevated lipids
Clinical features
Slow and insidious onset of a painful, red, and swollen eyelid without a history of foreign body or trauma.
External hordeolum “Stye”:
- Pain, edema, and swelling are localized to a discrete area of the eyelid that is tender to palpation
Internal hordeolum:
- Present with more diffuse tenderness and erythema of the lid given the relatively larger meibomian gland
Diagnosis
Differential diagnosis:
- Chalazion: Classically a hordeolum appears as a small pustule along the margin of the eyelid and can be differentiated from a chalazion which tends to involve less of an inflammatory response and follows a more chronic course
- Basal cell carcinoma
- Pneumo-Orbita(rare)
- Preseptal cellulitis
- Sebaceous gland carcinoma
- Squamous cell carcinoma
Management
Conservative management:
Gold standard
- Warm compresses
- Lid massage
- Mild soap/shampoo
Topical antibiotic therapy:
Persistent lesions or larger lesions
- Macrolide antibiotic ointment: Erythromycin ophthalmic ointment
Topical steroids (short duration):
Significant swelling and pressure on the cornea
If infection spreads and progresses to a periorbital or orbital cellulitis:
- Systemic antibiotics
- Incision and drainage of a persistent abscess
- Tissue biopsy to rule out carcinoma