Hordeolum

Updated: April 26, 2024

Background

Hordeolum, a condition that is also known as a style, is the most common eyelid disease and is usually not life-threatening. It usually has a characteristic appearance of one lower side of your eyelid being swollen with bumps and pus pockets. This region contains oil glands that drain oil from the eyelashes. This usually happens when the eyelid becomes red and tender and can also be painful, although not so severe. If nothing is done, the redness could last for a long time.

Epidemiology

The precise incidence remains uncertain. It affects every age group and demographic, albeit with a slight rise in occurrence among patients aged 30–50. No discernible differences in prevalence have been noted among populations globally.

Anatomy

Pathophysiology

Bacterial Entry:
The major pathogens associated with this type of lesion have long been known, and they are primarily represented by Staphylococcus aureus that is part of the normal skin and mucous membrane flora.
The bacteria can enter through microscopic pathways around the eyelid or the hair follicles of the eyelashes, which are small abrasions or cracks in the skin.

Inflammation:
Once the bacteria get in the organ, the immune system sends out the inflammatory response as an introductory reaction.
In response to an invasion by microorganisms, the leukocytes move to the site to eliminate the infection.

Formation of abscess:
The bacteria create an abscess comprising a collection of pus, which can be formed inside the eyelid. Abscess normally develop along eyelid’s margin, either outside (external hordeolum or stye) or inside of it (internal hordeolum).

Etiology

Bacterial Infection: The main cause for a stye is a bacterial infection, caused from bacteria getting into eyes like Staphylococcus aureus, many people transfer it on themselves accidentally by touching the nose and the eye by rubbing.
Blockage of Oil Glands: The oil glands located beneath them may eventually get clogged. When the oil glands are clogged and thus prevent the flow of the oil, bacteria can become a part of the gland growing more inside of it and causing the infection.
Poor Hygiene: Take up good care, like not to go to bed with your face with makeup or else sometimes failing to wash your facial skin correctly might make you prone to this condition.
Wearing Contact Lenses: Wearing contact lenses over-night without previously disinfecting them or ignoring cleaning requirements might produce even more infectious eye diseases, such as styes.

Genetics

Prognostic Factors

Eye patient must be assured that in most cases for Hordeolum the prognosis will be good if treatment is right. However, there is a small possibility for the eye lump to come back. The significant majority of styes are spontaneously resolved without needing an adequate procedure and some complications or those leading to eye damage.

Clinical History

Age group: Hordeolum, sometimes referred to as a stye, can affect individuals of any age. Nonetheless, those between the ages of 20 and 50 are the ones who is more affected. Although it may strike anybody at any age, most often in adults, they can strike infants and the elderly.

Physical Examination

External Examination

Slit-Lamp Examination

Visual Acuity

Age group

Associated comorbidity

Blepharitis

Diabetes

Poor Hygiene

Contact Lenses

Weakened Immune System

Trichiasis

Allergic Reactions

Eye Rubbing

Eyelid Trauma

Hormonal Changes

Associated activity

Acuity of presentation

Eye discomfort: Tenderness or pain that is restricted to the affected eyelid.
Swelling: Frequently notices a lump or swelling in the vicinity of the lash.
Redness: The affected area may be swollen and red.
Watering: The affected eye may be tearing.

Differential Diagnoses

Chalazion

Blepharitis

Preseptal Cellulitis

Orbital Cellulitis

Dacryocystitis

Herpes Zoster Ophthalmicus

Allergic Conjunctivitis

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Self-care measures
Warm Compresses: Using warm and wet eye compresses for an affected eyelid for 10 to 15 minutes can assist up to three-four times daily. It helps in reducing pain & inflammation associated with eye.

Eyelid Hygiene: Maintain good eyelid hygiene. Nose-rubbings and eye-rubbings should be curtailed.

Medical Treatment
Topical Antibiotics:
Topical antibiotics Antibiotic topical creams or drops are common to treat against inflammation and infection.
Against the common injuries people mostly use erythromycin or bacitracin as antibiotics.

Steroid treatment:
Steroidal eye drops prescription is needed to alleviate the swelling and the healing process starts sooner. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

lifestyle-modifications-in-treating-hordeolum

Warm Compresses:
Warm compresses can be used by placing them over the affected eye for 10-15 minutes once in the morning and the evening time. It is necessary since the massaging facilitates the unblocking of the gland and eases the drainage.
Clean Environment:
Keep a check on the surroundings that you are most likely to be in e.g. bedroom, lounge, study room etc. to be dust-free.
Clean pillowcases, bedsheets, and towels on a regular basis to prevent any chances of bacteria.
Proper Hygiene:
Stop yourself from touching or rubbing around the affected eye.
Avoid Eye Makeup:
Keep off on eye make-up until the stye is fully healed. Makeup can make it worse.

Avoid Contact Lenses:
If you wear contact lenses rather than glasses it may affect the condition in certain cases.
Humidifier:
If the environment is dry, use humidifier as the dry air can cause the symptoms to get worse.
Diet:
Pay attention to your diet by keeping it nutritious, with vitamins and minerals, to strengthen your immune system.
Proper Rest:
Try your best to get more sleep. Enough rest is important in strengthening your body and fighting the disease.

Effectiveness of antibiotics in treating Hordeolum

Cephalexin: Cephalexin is an antibiotic oral preparation which possesses a broad-spectrum of activity and is usually used for the treatment of different types of bacterial infections. 
Erythromycin base: It is primarily used for Staphylococcus aureus, mostly suitable for the corneal and conjunctival infections and for the antibacterial infections having higher resistant traits.
Doxycycline: Doxycycline, an antibiotic, can be used for treating certain types of hordeolum. Doxycycline is capable of lowering inflammations and thereby helps in relieving the swelling and pain associated with this condition.

role-of-intervention-with-procedure-in-treating-hordeolum

Incision and Drainage:

Your ophthalmologist might make a little incision to drain the pus if the stye is severe and painful. The standard procedure for this is local anaesthesia. The doctor might recommend antibiotic ointment after draining.

role-of-management-in-treating-hordeolum

Initial Care:
Initiate with warm compress (for 10-15 minutes) with 3-4 repetitions every day.
Maintain good eyelid hygiene.
Medical Treatment:
Topical antibiotic ointments such as erythromycin and bacitracin can be used in treating this condition.
To get rid of the infection if the disease is intense, oral antibiotics (doxycycline,) may be prescribed.
Surgical Intervention (if necessary):
Surgical treatment by incision and drainage may be necessary for styes that are larger or persistent. A trained surgeon should do this.
Follow-up:
Re-access the patient after precisely 48 hours from the beginning of treatment.