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Diagnosis: A Hordeolum

Greenberg, Michael I. MD, MPH

doi: 10.1097/01.EEM.0000334137.10313.42
DOORWAY DIAGNOSIS

Dr. Greenberg is a professor of emergency medicine and public health, the chief of the division of occupational/environmental emergency medicine, and the toxicology fellowship program director at MCP Hahnemann School of Medicine in Philadelphia.

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This patient is suffering from a hordeolum or stye, one of the most common ocular complaints evaluated in the emergency department or primary care office. Patients will usually present with an acutely swollen and edematous upper or lower eyelid. Vision will be normal. There may be an associated conjunctivitis and possibly mucopurulent discharge. The lids will be extremely sensitive to palpation, and there may be an associated pustular, pimple-like lesion at the lid margin or less commonly at the dermis.

Hordeola are caused by obstructions of the oil-producing meibomian glands located in the eyelid tarsal plates. Obstruction of these glands results in a foreign body reaction with associated inflammation. Histopathologic examination of a hordeolum reveals a focal collection of polymorphonuclear leukocytes and necrotic tissue in a small abscess.

Hordeola tend to be self-limited and often resolve spontaneously within about one week. When patients seek treatment for this problem, they should be instructed to use frequent warm compresses and on general eyelid hygiene. In some cases, topical anti-inflammatory medication may be helpful.

Antibiotic therapy may be necessary in cases involving secondary bacterial infection. An important treatment pitfall is the failure to apply warm compresses with an adequate degree of frequency. Patients should be instructed to apply warm compresses at least every two hours for 10 to 15 minutes per application.

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Figure

If this treatment fails, intralesional injection of steroids or surgical incision and drainage may be indicated. It is important to remember that local steroid injection may cause loss of skin pigmentation, and has been associated with vascular occlusion and visual loss.

Carcinoma of the eyelid can be misdiagnosed clinically as a recurrent hordeolum. In the case of recurrent hordeolum, the emergency physician should be certain to refer the patient to an appropriate specialist for follow-up.

© 2002 Lippincott Williams & Wilkins, Inc.