Hordeolum

Question 1

Aetiology

Answer 1

Acute localised infection of the sebaceous and apocrine glands of the upper and lower lids. Usually caused by staphylococcal bacteria.

2 types:
EXTERNAL (stye) - infection of lash follicle and its associated gland of Zeiss or Moll
INTERNAL - infection of meibomian gland, more painful.

Untreated internal hordeolum can lead to chalazion or preseptal cellulitis.

Question 2

Predisposing factors

Answer 2

Poor eyelid hygiene
Inflammatory eyelid disease

Question 3

Symptoms

Answer 3

Localised pain, swelling, tenderness, redness of the eyelid
Watering

Question 4

Signs

Answer 4

EXTERNAL - localised tender erythematous swelling of the lid margin, multiple abscesses can affect the entire lid margin, point anteriorly through skin

INTERNAL - tender erythematous swelling of the tarsal plate, point anteriorly through skin or posteriorly through conjunctiva, more painful than external

Question 5

Non-pharmacological management

Answer 5

Most resolve spontaneously or discharge, before resolving

Hot compresses with a spoon (40-45 degrees) for 10 minutes multiple times throughout day can be helpful.
Lid hygiene routine for associated blepharitis.

Removal of associated lash follicle can help.

In cases that do not discharge, refer for incision.

Question 6

Pharmacological management

Answer 6

Course of topical CPL in cases with mucopurulent discharge
If they do not respond to topical antibiotic, give broad spectrum systemic antibiotic
In more severe cases, short course of topical steroid can help.

Question 7

Refer?

Answer 7

Not required. If for any reason the Px is referred, hospital may removal lesion by incision, however rarely done if acute infection present.