hordeolum

**Definition:** Acute suppurative inflammation (abscess) of the eyelid glands. Latin "hordeolum" = barley grain.

**Types:** - **External hordeolum (stye):** Infection of the glands of Zeis (modified sebaceous glands at the lash follicle) or glands of Moll (apocrine sweat glands). Points at the eyelid margin, near the lashes. - **Internal hordeolum:** Infection of the meibomian gland (tarsal gland) within the tarsal plate. Deeper, more painful, and may point toward the conjunctival side. It can progress to a chalazion.

**Etiology/Pathophysiology:** - *Staphylococcus aureus* causes about 90–95% of cases. - Gland duct obstruction leads to stasis of secretions, then bacterial superinfection, then acute inflammation and abscess formation. - Risk factors: blepharitis (staphylococcal or seborrheic), rosacea, diabetes, immunosuppression, poor eyelid hygiene, contact lens use, prior hordeola.

**Clinical presentation:** - Acute onset of a localized, tender, red, swollen eyelid nodule, often with a visible yellow point of pus. - Pain, tearing, foreign-body sensation, and mild ptosis from swelling. - Usually no fever and no visual loss.

**Diagnosis:** Clinical. Consider biopsy for recurrent lesions in the same location in older adults to rule out sebaceous cell carcinoma (a masquerade syndrome).

**Management:** - Warm compresses 10–15 min, 3–4 times/day, plus lid hygiene and gentle massage. Most resolve spontaneously in 1–2 weeks. - Do not squeeze or pop it. - Incision and drainage if it persists or is large. - Topical antibiotics (erythromycin ointment) have little evidence of benefit but are sometimes used. Oral antibiotics (e.g., doxycycline, cephalexin; consider MRSA coverage) are for spreading cellulitis or significant blepharitis.

**Complications:** Chalazion formation, preseptal (periorbital) cellulitis, rarely orbital cellulitis (suspect if there is proptosis, pain with eye movement, ophthalmoplegia, or decreased vision), and eyelid deformity or lash loss.

**High-yield comparison, hordeolum vs. chalazion:** - Hordeolum: acute, painful, infectious (S. aureus), at the lid margin (external) or deep (internal). - Chalazion: chronic, painless, sterile lipogranulomatous inflammation from meibomian gland obstruction, located away from the lid margin on the tarsal plate. Histology shows granulomatous inflammation with lipid. Treat with warm compresses, intralesional steroid injection, or incision and curettage.

**Boards pearl:** A tender red eyelid bump at the lash line in a patient with blepharitis means hordeolum. A painless, firm, non-tender eyelid nodule for weeks means chalazion. A recurrent "chalazion" in the same site in an older patient should prompt biopsy for sebaceous carcinoma.