Ocular System


Acute bacterial infection of eyelids.

Acute bacterial infection of eyelids.


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.
Stye (external Hordeolum) | Public Domain

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.
hordeolum of the lower eyelid | S Bhimji MD


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


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
© Jorge Muniz, MedComic


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

Leave a Reply