What is a hordeola?

Definition

A hordeolum is a small infection of the glands in the eye,
located in the eyelids. The infection causes a red bump on the eyelid that may
look like a pimple. This type of infection, also known as a sty, is
usually quite painful. There are two types of hordeola: external, which occurs
when the infection is external to the eyelash line, and internal, which occurs
when the infection is inside the eyelash line. Hordeola are often easily
diagnosed, and prompt treatment often prevents progression of the infection.

Causes

A hordeolum is caused by a blockage in the small glands located along the eyelid margin. These glands produce oil, and the blockage prevents normal drainage of the gland. If bacteria are trapped in the gland, an infection can develop. Fluid and pus cause the area to become red and inflamed. In 90 to 95 percent of cases, the resulting infection is caused by the bacterium
Staphylococcus aureus (also known as staph). It is possible to have more than one hordeolum at a time, and it is common for them to recur.

Risk Factors

Hordeolum infection is a common condition, although the exact incidence in the United States is not known. Some conditions may increase the risk of developing a hordeolum; these conditions include poor eyelid hygiene, chronic illness, and a previous hordeolum (hordeola often recur in the same eyelid).

Symptoms

A hordeolum usually begins as a red and swollen area on or in the eyelid. Often, the area is tender and painful. In addition to the red, painful bump, other symptoms include tearing of the eye and blurred vision or a sensation of a foreign body or scratchiness in the eye. Sometimes the swollen area has a point or yellowish spot. This area is where the discharge of pus will occur when the hordeolum drains.

Internal hordeola are usually more painful and are less likely to come to a point without the assistance of a doctor. If a person experiences redness and painful swelling in the eye, or any change in vision, he or she should consult an eye doctor immediately because these symptoms may be caused by other health conditions.

Screening and Diagnosis

In most cases, a simple eye exam is all that is necessary to confirm the diagnosis of a hordeolum. Other than looking at the person’s eye, special tests are not usually necessary for diagnosis.

Treatment and Therapy

Often, hordeola resolve spontaneously on their own. In these cases, only hot
compresses to assist the drainage are needed. Warm compresses can be applied four
to six times a day for several minutes a session. However, if they do not drain on
their own, hordeola often respond quickly to simple treatment from a doctor. If
left untreated, the infection may continue to grow or may lead to other
conditions. Chalazia occurs when the gland is blocked but no infection is present.
Cellulitis occurs when the infection spreads to the tissue
of the eyelid or beyond.

Drainage of the lesion is the first step in treating the hordeolum. If the hordeolum does not drain on its own, a doctor may assist by lancing the hordeolum. The pus and contents of the swollen area can then be drained. One should not lance the hordeolum without the assistance of a doctor; permanent damage to the eye or eyelid can occur.

In some cases, antibiotics are also given to ensure that the entire
infection is eliminated. Antibiotics may be given in oral form, or as eye drops or
eye ointment. In many cases, antibiotics alone are ineffective.

Prevention and Outcomes

The best prevention against developing a hordeolum is to keep the area around the eye as clean as possible. One should always wash his or her hands thoroughly before touching one’s eyes and should refrain from rubbing the eyes.

Although it may not be possible to prevent the development of every hordeolum, obtaining prompt treatment when one occurs is the best way to prevent recurrences. One should not attempt to drain the hordeolum. Any squeezing or poking at the hordeolum may cause more damage. The infection may be spread inadvertently, or damage to the eye could result.

Finally, one should contact a doctor immediately if experiencing vision problems, if there is a blister or crusting on the eyelid, if the white of the eye becomes red, if the hordeolum bleeds, or if experiencing pain.

Bibliography

Cassel, Gary H., Michael D. Billig, and Harry G. Randall. The Eye Book: A Complete Guide to Eye Disorders and Health. Baltimore: Johns Hopkins University Press, 2001.

“Chalazion/Hordeolum.” In The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, edited by J. P. Ehler et al. 5th ed. Baltimore: Lippincott Williams & Wilkins, 2008.

Fort, G. G., et al. “Hordeolum (Stye).” In Ferri’s Clinical Advisor 2011: Instant Diagnosis and Treatment, edited by Fred F. Ferri. Philadelphia: Mosby/Elsevier, 2011.

Mueller, J. B., et al. “Ocular Infection and Inflammation.” Emergency Medicine Clinics of North America 26 (2008): 57.

Pasternak, A., and B. Irish. “Ophthalmologic Infections in Primary Care.” Clinics in Family Practice 6 (2004): 19-33.

Riordan-Eva, Paul, and John P. Whitcher. Vaughan and Asbury’s General Ophthalmology. 17th ed. New York: Lange Medical Books/McGraw-Hill, 2007.

Sutton, Amy L., ed. Eye Care Sourcebook: Basic Consumer Health Information About Eye Care and Eye Disorders. 3d ed. Detroit: Omnigraphics, 2008.