1. Hordeolum (Sty)
Presentation
The patient complains of redness, swelling, and pain in the eyelid, perhaps at the base
of an eyelash (sty or external hordeolum) or deep within the lid (meibomianitis or
internal hordeolum, best appreciated with the lid everted) perhaps with conjunctivitis
and purulent drainage.
What to do:
• Examine the eye, including visual acuity and inversion of lids (see "Conjunctival
FB" for technique).
• Show patient how to instill antibiotic drops or ointment (e.g., sulfa, tobramycin,
erythromycin, gentamycin) into his lower conjunctival sac and apply warm tap
water compresses for 10 minutes per hour or 20 minutes four time daily.
• Instruct the patient to return to the ophthalmologist or the ED if the problem is
not clearly resolving in two days, or if it gets any worse.
• If the abscess does not spontaneously drain or resolve in two days, you may
incise it with the tip of a #11 blades or small needle, with the same follow up
instructions.
What not to do:
• Do not miss a periorbital cellulitis, which is a severe infection and requires
agressive systemic antibiotic treatment.
Discussion
The terminology of the two types of hordeolum has become confusing. Meibomian
glands run vertically, within the tarsal plate, open at tiny puncta along the lid margin,
and secrete oil to coat the tear film. The glands of Zeiss and Moll are the sebaceous
glands opening into the follicles of the eyelashes. Both can become occluded and
superinfected, producing meibomianitis (internal hordeolum) or a sty (external
hordeolum). The ED care of both acute infections is the same. A chronic granuloma of
the meibomian gland is called a chalazion, will not drain, and requires excision.