Stye (Hordeolum)

Acute, localized, suppurative infection of the eyelid glands, usually caused by Staphylococcus aureus, characterized by a painful, erythematous swelling of the eyelid.

Aetiology

Causative organism:
  • Staphylococcus aureus (most common)
  • Less commonly: Streptococcus species
Predisposing factors:
  • Poor eyelid hygiene
  • Chronic blepharitis
  • Meibomian gland dysfunction
  • Diabetes mellitus
  • Immunosuppression
  • Frequent eye rubbing

Classification

External Hordeolum

  • Infection of glands of Zeis (sebaceous) or glands of Moll (apocrine)
  • Located at the eyelid margin
  • Most common type

Internal Hordeolum

  • Infection of meibomian glands
  • Located within the tarsal plate
  • Often more painful and deeper

Clinical presentation

Symptoms

  • Localized eyelid pain
  • Tenderness
  • Swelling
  • Redness
  • Foreign body sensation
  • Mild tearing

Signs

External Hordeolum:
  • Localized, erythematous, tender nodule
  • Often visible yellow pustule at lash line
  • Surrounding eyelid edema
Internal Hordeolum:
  • Diffuse eyelid swelling
  • Marked tenderness
  • Conjunctival hyperemia
  • May evert eyelid to see lesion
notion image

Management

Conservative Treatment (First-Line)

  • Warm compresses
    • 10–15 minutes
    • 3–4 times daily
  • Gentle lid massage
  • Eyelid hygiene

Medical Therapy

  • Topical antibiotic ointment if discharge present
    • Erythromycin 0.7% ointment 4x1
    • Chloramphenicol 1% ointment 3x1
    • Chloramphenicol 0.25% ED 3x1
  • Systemic antibiotics rarely required (extensive cellulitis)
    • Erythromycin 500mg PO 2x1
    • Dicloxacyclin 250mg PO 4x1
    • Doxycyclin 100mg PO 2x1

Surgical Management

  • Incision and drainage
    • Internal hordeoum → vertical incision
    • External hordeolum → horizontal incision
  • Indicated if:
    • No resolution after conservative therapy
    • Large abscess formation