A hordeolum is an acute inflammatory process affecting the eyelid and arising from the Meibomian (posterior) or Zeis (anterior) glands. It is most often infectious and usually caused by Staphylococcus aureus. When infection involves the meibomian glands, it is called meibomianitis.
PHYSICAL FINDINGS & CLINICAL
- Abrupt onset with pain and erythema of the eyelid
- Localized, tender mass in the eyelid
- May be associated with blepharitis
- External hordeolum: points toward the skin surface of the lid and may spontaneously drain
- Internal hordeolum: can point toward the conjunctival side of the lid and may cause conjunctival inflammation
- 75% to 95% of cases are caused by S. aureus.
- Occasional cases are caused by Streptococcus pneumoniae, other streptococci, gram-negative enteric organisms, or mixed bacterial flora.
- Eyelid abscess
- Allergy or contact dermatitis with conjunctival edema
- Acute dacryocystitis
- Herpes simplex infection
- Cellulitis of the eyelid
- Generally, none are necessary.
- If incision and drainage are performed, specimens should be sent for bacterial culture.
External style (eyelash follicle): Usually responds to warm compresses and will drain spontaneously
ACUTE GENERAL Rx
- Systemic antibiotics generally not necessary
- For internal style, use hot packs plus oral dicloxacillin 500 mg qid x 7 days. If suspecting MRSA, use trimethoprim-sulfamethoxazole DS bid in place of dicloxacillin. In patients with hospital-acquired infection, consider linezolid 600 mg PO bid.
- For external style, topical erythromycin ophthalmic ointment applied to the lid margins two to four times daily until resolution may be helpful in some cases.
- Incision and drainage: rarely needed but should be considered for progressive infections