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.
A: External hordeolum (black arrow) and an internal hordeolum (white arrow). B: External hordeolum on upper lid with surrounding erythema. (Reproduced with permission from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley HS. The Color Atlas and Synopsis of Family Medicine, 3rd ed. McGraw-Hill, 2019.)
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.
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.
A: Chalazion viewed from internal eyelid showing the yellow lipogranulomatous material. B: Chalazion present for 4 months with minimal symptoms but cosmetically unappealing. (Reproduced with permission from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley HS. The Color Atlas and Synopsis of Family Medicine, 3rd ed. McGraw-Hill, 2019.)
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, which is strongly associated with acne rosacea.
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 ...