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PATIENT STORY

A 35-year-old woman presented with a tender nodule on the upper eyelid along with crusting and erythema to both eyelids (Figure 15-1). The upper eyelid had a large external hordeolum. When the lower eyelid was inverted an internal hordeolum was also present. The physician recommended that she apply warm moist compresses to her eyelids four times a day. Her hordeola resolved within 7 days.

FIGURE 15-1

External hordeolum (black arrow) and an internal hordeolum (white arrow). (Reproduced with permission from Richard P. Usatine, MD.)

INTRODUCTION

A hordeolum is an acute painful infection of the glands of the eyelid, usually caused by bacteria. Hordeola can be located on the internal or external eyelid. Internal hordeola that do not completely resolve become cysts called chalazia. External hordeola are commonly known as styes.

SYNONYMS

Stye (external hordeolum).

EPIDEMIOLOGY

  • Unclear incidence or prevalence in the United States, but often stated to be more common in school-aged children and adults 30 to 50 years old.

  • In one study in school-aged children in Brazil, the prevalence of chalazion was found to be 0.2% and that of hordeolum was 0.3%.1

ETIOLOGY AND PATHOPHYSIOLOGY

HORDEOLUM (ACUTELY TENDER NODULE IN THE EYE)

  • Infection in the meibomian gland (internal hordeolum), often resolves into a chalazion (Figure 15-1).

  • Infection in the Zeiss or Moll glands (external hordeolum) (Figures 15-2 and 15-3).

  • Staphylococcus aureus is the causative agent in most cases.

FIGURE 15-2

External hordeolum on upper lid with surrounding erythema. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 15-3

External hordeolum with visible purulence and the normal contour of the eyelid is disrupted. (Reproduced with permission from Richard P. Usatine, MD.)

CHALAZION

  • Meibomian gland becomes blocked, often in a patient with blepharitis.

  • Blocked meibomian gland's duct releases gland contents into the soft tissue of eyelid.

  • Gland contents cause a lipogranulomatous reaction (Figure 15-4).

  • Reaction can cause acute tenderness and erythema, which then resolves into a chronic nodule (Figure 15-5).

  • Demodex mites have been associated with chalazia.2

FIGURE 15-4

Chalazion viewed from internal eyelid showing the yellow lipogranulomatous material. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 15-5

Chalazion present for 4 months with minimal symptoms but cosmetically unappealing. (Reproduced with permission from Richard P. ...

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