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Hordeolum is an acute infection that is commonly due to Staphylococcus aureus. It is characterized by a localized red, swollen, acutely tender area on the upper or lower lid (eFigure 7–7). Internal hordeolum is a meibomian gland abscess that usually points onto the conjunctival surface of the lid; external hordeolum, or stye, is usually smaller and on the lid margin and is an abscess of the gland of Zeis.

eFigure 7–7.

External hordeolum (black arrow) and chalazion (white arrow), which developed from an internal hordeolum. (Used, with permission, from Richard P. Usatine, MD in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley H, Tysinger J. The Color Atlas of Family Medicine. McGraw-Hill, 2009.)

Warm compresses are helpful. Incision may be indicated if resolution does not begin within 48 hours. An antibiotic ointment (bacitracin or erythromycin) applied to the lid every 3 hours may be beneficial during the acute stage. Internal hordeolum may lead to generalized cellulitis of the lid.

Bragg  KJ  et al. Hordeolum. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2017 Oct 10.
[PubMed: 28723014]
Willmann  D  et al. Stye. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2017 Oct 13.
[PubMed: 29083787]


Chalazion is a common granulomatous inflammation of a meibomian gland that may follow an internal hordeolum (eFigure 7–7) (eFigure 7–8). It is characterized by a hard, nontender swelling on the upper or lower lid with redness and swelling of the adjacent conjunctiva. Initial treatment is with warm compresses. If resolution has not occurred by 2–3 weeks, incision and curettage is indicated. Corticosteroid injection may also be effective.

eFigure 7–8.

Chalazion, right upper eyelid. (From M. Reza Vagefi. Reproduced, with permission, from Riordan-Eva P, Augsburger JJ. Vaughan & Asbury’s General Ophthalmology, 19th ed. McGraw-Hill, 2018.)


Blepharitis is a common chronic bilateral inflammatory condition of the lid margins. Anterior blepharitis involves the lid skin, eyelashes, and associated glands. It may be ulcerative, because of infection by staphylococci, or seborrheic in association with seborrhea of the scalp, brows, and ears. Posterior blepharitis results from inflammation of the meibomian glands. There may be bacterial infection, particularly with staphylococci, or primary glandular dysfunction, in which there is a strong association with acne rosacea.

Clinical Findings

Symptoms are irritation, burning, and itching. In anterior blepharitis, the eyes are “red-rimmed” and scales or collerettes can be seen clinging to the lashes (eFigure 7–9A). In posterior blepharitis, the lid margins are hyperemic with telangiectasias, and the meibomian glands and their orifices are inflamed (eFigure 7–9B). The lid ...

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