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A 35-year-old woman presented with a tender nodule on the upper eyelid along with crusting and erythema to both eyelids (Figure 13-1). 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 4 times a day. Her hordeola resolved within 7 days.

Figure 13-1

External hordeolum (black arrow) and an internal hordeolum (white arrow) (Courtesy of Richard P. Usatine, MD.)

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.

Stye (external hordeolum).

  • Unclear incidence or prevalence in the United States, but often stated to be more common in school-age children and adults 30 to 50 years old.
  • In one study of school-age children in Brazil, the prevalence of chalazion was found to be 0.2% and that of hordeolum was 0.3%.1

Hordeolum (Acutely Tender Nodule in the Eye)

  • Infection in the meibomian gland (internal hordeolum), often resolves into a chalazion (Figure 13-1).
  • Infection in the Zeiss or Moll gland (external hordeolum) (Figures 13-2 and 13-3).
  • Staphylococcus aureus is the causative agent in most cases.

Figure 13-2

External hordeolum on upper lid with surrounding erythema. (Courtesy of Richard P. Usatine, MD.)

Figure 13-3

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


  • 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 13-4).
  • Reaction can cause acute tenderness and erythema, which then resolves into a chronic nodule (Figure 13-5).

Figure 13-4

Chalazion viewed from internal eyelid showing the yellow lipogranulomatous material. (Courtesy of Richard P. Usatine, MD.)

Figure 13-5

Chalazion present for 4 months with minimal symptoms but cosmetically unappealing. (Courtesy of Richard P. Usatine, MD.)

  • Hordeolum: S. aureus blepharitis, previous hordeolum.
  • Chalazion: Seborrheic blepharitis and rosacea.

  • Chalazion and hordeolum are clinical diagnoses.
  • Chalazion is a nontender nodule on the eyelid.
  • Hordeolum
    • Tenderness and erythema localized to a ...

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