Hordeolum (Stye): An Easy Guide to Eye Infection

Hordeolum, or stye, is a common eye infection involving upper and lower eyelids. It is an infection of the eyelid’s oil glands that can be internal or external. The classical sign of the hordeolum is a pimple filled with pus around your eyelid or eyelash margin. It is commonly caused by the bacteria Staph Aureus, resulting in a pimple or bump that is painful, red, and tender to touch. The risk factors for hordeolum include poor hygiene, using old or contaminated makeup, and not keeping eye area clean. It is a self-limiting condition that will go away in a few days, but your doctor may prescribe local antibiotics or ointments to speed up the healing process.¹Lindsley, K., Nichols, J. J., & Dickersin, K. (2013). Interventions for acute internal hordeolum. The Cochrane database of systematic reviews, 4(4), CD007742. https://doi.org/10.1002/14651858.CD007742.pub3

What is Hordeolum?

It is an acute and painful bacterial infection of the upper or lower eyelid commonly caused by Staphylococcus Aureus bacteria and Staphylococcus Epidermidis bacteria being the second common cause. The bacteria causes infection and inflammation of the oil glands along the eyelid. It appears as a small red and tender bump on the edge of your eyelid.²Willmann D, Guier CP, Patel BC, et al. Stye. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459349/

Types of Hordeolum

There are two types depending on the location of the infection. They may appear on both the upper and lower eyelids. The types include:³(Bragg KJ, Le PH, Le JK. Hordeolum. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441985)

The External Hordeolum

These arise from infection of glands in the eyelash follicle or lid margin, specifically the gland of Zeis (oil gland) or Moll glands (sweat gland around the eye) by S.aureus, which causes pain and swelling along the eyelash margin with pus pocket. It produces a stye appearance outside or on the lash line.⁴Cheng, K., Law, A., Guo, M., Wieland, L. S., Shen, X., & Lao, L. (2017). Acupuncture for acute hordeolum. The Cochrane database of systematic reviews, 2(2), CD011075. https://doi.org/10.1002/14651858.CD011075.pub2

The Internal Hordeolum

It is a bacterial infection that occurs inside the eyelid and causes inflammation of the meibomian gland (the gland that produces an oily layer to ensure proper lubrication of your eye). When this gland gets infected by S. aureus, it results in swelling just under the conjunctival side of the eyelid. Due to the deeper position of the gland under the eyelid, the internal hordeolum has a less defined appearance than the external hordeolum.

The difference between a Hordeolum & a Chalazion

Both hordeolum and chalazion appear similar, but they have different causes. Hordeolum occurs due to bacterial infection of the oil glands and eyelash follicles. In contrast, chalazion is an inflammatory process that occurs secondary to obstruction of the oil glands of the eyelid (meibomian gland) or oil gland at the eyelash follicle (zeis gland). Chalazion commonly occurs if acute internal hordeolum is not treated effectively. Treatment of chalazion typically involves warm compresses, steroid injections, or surgical removal if persistent, while hordeolum is treated with warm compresses, antibiotics, or ointments if an infection is present.⁵Lindsley, K., Nichols, J. J., & Dickersin, K. (2017). Non-surgical interventions for acute internal hordeolum. The Cochrane database of systematic reviews, 1(1), CD007742. https://doi.org/10.1002/14651858.CD007742.pub4

Symptoms 

The symptoms vary from person to person, but commonly, you may experience;⁶Mueller, J. B., & McStay, C. M. (2008). Ocular infection and inflammation. Emergency Medicine Clinics of North America, 26(1), 57–vi. https://doi.org/10.1016/j.emc.2007.10.004

• Painful bump around your upper or lower eyelid with visible pus (fluid)
• Redness and swelling around the affected side
• The area is tender to touch
• Having itching in your eye
• Crustiness on the eyelid or eyelash line
• You may feel like something is in your eye
• Become sensitive to bright light
• Affected eye may get watery
• If you have internal hordeolum, you may have diffuse or general tenderness and swelling inside the eyelid.

Risk Factors 

You may develop Stye if you have any of the following risk factors;

• Poor hygiene
• If you had one before (history of stye)
• Wear contact lenses
• Apply makeup that is old or contaminated
• Not keeping your eye area clean
• Have other eye conditions like blepharitis (inflammation of the eyelid)
• Have systemic conditions like seborrheic dermatitis, diabetes, or rosacea (skin infection involving face)

Diagnosis of the Hordeolum

In most cases, your doctor can diagnose a hordeolum by simply reviewing your medical history and conducting a physical examination, as the characteristic appearance of the condition is often evident. Medical tests are usually unnecessary for diagnosis.⁷ITE Loth, C., Miller, C. V., Haritoglou, C., & Messmer, E. S. B. M. (2022). Hordeolum and Chalazion : (Differential)Diagnose und Therapie [Hordeolum and chalazion : (Differential) diagnosis and treatment]. Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 119(1), 97–108. https://doi.org/10.1007/s00347-021-01436-y
Your doctor may;

• Ask about your symptoms, including pain, swelling, or tenderness around your eyelids.
• Ask your medical history to get information about any health problems contributing to the eye problem.
• May do a physical examination of the eye, including eyelid structure, eyelash appearance, or skin texture around the eye
• May evaluate eyelid margins, eyelash base, and area inside the eyelid for oil glands using bright light
• Rarely are imaging and tests required if the complications cause periorbital or orbital cellulitis.
• Sustained or repeated eye bumps may signal the presence of cancerous cells and require a biopsy of the eye tissue to study the condition further.

Treatment for the Hordeolum

Hordeolum is typically a self-resolving condition that often clears up on its own within a week. However, if your symptoms persist or worsen, it’s important to seek medical attention promptly. Your doctor may suggest the following approaches for treatment:⁸McGinley T. C., Jr (2022). Adult Eye Conditions: Common Eye Conditions. FP Essentials, 519, 11–18.

• Warm compression with a cloth for 15 minutes each 3-4 times a day is the gold standard treatment for hordeolum; it softens the tissue, facilitates drainage, and helps reduce pain and swelling.
• A gentle massage with your finger on the nodule will assist if any blockage is present in the eyelid.
• Both internal and external styes are managed similarly. To speed up the recovery and prevent the spread of the infection, local ointment or cream is suggested. It takes around 7-10 days to resolve the stye.
• Antibiotics are rarely recommended unless complications occur, like orbital cellulitis. Because antibiotics are unlikely to improve hordeolum.⁹Alsoudi, A. F., Ton, L., Ashraf, D. C., Idowu, O. O., Kong, A. W., Wang, L., Kersten, R. C., Winn, B. J., Grob, S. R., & Vagefi, M. R. (2022). Efficacy of Care and Antibiotic Use for Chalazia and Hordeola. Eye & contact lens, 48(4), 162–168. https://doi.org/10.1097/ICL.0000000000000859
• If your hordeolum is large, your doctor may recommend that you see an ophthalmologist for drainage of the nodule. This will clean the nodule and prevent infection from spreading.
• Limited evidence suggests that treatment with topical or systemic antibiotics and/or glucocorticoids does not significantly enhance healing.¹⁰Alsoudi AF, Ton L, Ashraf DC, Idowu OO, Kong AW, Wang L, Kersten RC, Winn BJ, Grob SR, Vagefi MR. Efficacy of Care and Antibiotic Use for Chalazia and Hordeola. Eye Contact Lens. 2022 Apr 1;48(4):162-168. doi: 10.1097/ICL.0000000000000859. PMID: 35296627; PMCID: PMC8931268. However, individuals experiencing frequent hordeola due to rosacea-associated blepharitis and not responding adequately to warm compresses and mechanical debris removal may benefit from a combination of topical antibiotics and corticosteroid ointment. These patients must be under the care of an ophthalmologist due to potential ocular complications linked to topical glucocorticoids.

Prognosis 

Typically, people experience 2-3 styes in their lifetime. Although they may irritate the eye or cause discomfort, Hordeolum (styes) are usually harmless. They typically go away after a few days. Home care, like warm and wet cloth compressions, helps speed up the recovery process. You may want to cover it with makeup, but don’t; it will worsen the bump and make it more infected and painful.

How can we prevent getting a Hordeolum?

To prevent the chance of getting a hordeolum, you should follow some measures, including;

• Wash your hands before touching your eyes or putting on contact lens
• Replacing old makeup every few months
• Protect your eyes from pollution and dust by wearing sunglasses
• Try not to rub your eyes frequently
• Avoid wearing makeup and contact lenses till your hordeolum heals.
• Don’t pop the stye

When should I consider visiting a doctor?

If you experience persistent pain and discomfort due to a lump on your eyelid, it’s advisable to consult a doctor. Your doctor may provide more options to treat the condition, such as draining the fluid or surgery.
Consider going to a doctor if the lump is;

• Not reducing in size with warm compressions and gentle massage
• Painful and infectious
• Making it difficult for you to see
• Irritates your eyeball or the inner side of the eye
• It doesn’t resolve even after a month
• If home treatment is not working for your lump

Can a Hordeolum turn into a Chalazion?

A hordeolum (stye) on the inner side of the eyelid can turn into a chalazion if it doesn’t resolve with warm compresses and becomes chronic.

Is a Hordeolum (Stye) Contagious?

Hordeolum (stye) is not contagious, but bacteria may spread to other nearby tissues. This is why it’s important to wash your hands before and after touching the eyes and keep your eyes clean. Also, avoid touching the bump to reduce the discomfort and irritation.

Are antibiotics helpful for a Hordeolum or a Chalazion?

Local eye ointment is recommended if recovery from warm compression is slow or your bump is very painful. Antibiotics, however, are unlikely to resolve the hordeolum.¹¹Alsoudi, A. F., Ton, L., Ashraf, D. C., Idowu, O. O., Kong, A. W., Wang, L., Kersten, R. C., Winn, B. J., Grob, S. R., & Vagefi, M. R. (2022). Efficacy of Care and Antibiotic Use for Chalazia and Hordeola. Eye & contact lens, 48(4), 162–168. https://doi.org/10.1097/ICL.0000000000000859

Conclusion

In conclusion, Hordeolum, or stye, is a common bacterial infection characterized by a tender, red lump on the eyelid. It can occur externally or internally, often due to poor eye hygiene or using contaminated products. While usually self-limiting and healing within days, warm compressions can aid recovery. If persistent, medical attention may be needed. Preventative measures, such as maintaining good eye hygiene and avoiding touching the eyes with unwashed hands, can help reduce recurrence risk.

Refrences

• 1
  Lindsley, K., Nichols, J. J., & Dickersin, K. (2013). Interventions for acute internal hordeolum. The Cochrane database of systematic reviews, 4(4), CD007742. https://doi.org/10.1002/14651858.CD007742.pub3
• 2
  Willmann D, Guier CP, Patel BC, et al. Stye. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459349/
• 3
  (Bragg KJ, Le PH, Le JK. Hordeolum. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441985)
• 4
  Cheng, K., Law, A., Guo, M., Wieland, L. S., Shen, X., & Lao, L. (2017). Acupuncture for acute hordeolum. The Cochrane database of systematic reviews, 2(2), CD011075. https://doi.org/10.1002/14651858.CD011075.pub2
• 5
  Lindsley, K., Nichols, J. J., & Dickersin, K. (2017). Non-surgical interventions for acute internal hordeolum. The Cochrane database of systematic reviews, 1(1), CD007742. https://doi.org/10.1002/14651858.CD007742.pub4
• 6
  Mueller, J. B., & McStay, C. M. (2008). Ocular infection and inflammation. Emergency Medicine Clinics of North America, 26(1), 57–vi. https://doi.org/10.1016/j.emc.2007.10.004
• 7
  ITE Loth, C., Miller, C. V., Haritoglou, C., & Messmer, E. S. B. M. (2022). Hordeolum and Chalazion : (Differential)Diagnose und Therapie [Hordeolum and chalazion : (Differential) diagnosis and treatment]. Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 119(1), 97–108. https://doi.org/10.1007/s00347-021-01436-y
• 8
  McGinley T. C., Jr (2022). Adult Eye Conditions: Common Eye Conditions. FP Essentials, 519, 11–18.
• 9
  Alsoudi, A. F., Ton, L., Ashraf, D. C., Idowu, O. O., Kong, A. W., Wang, L., Kersten, R. C., Winn, B. J., Grob, S. R., & Vagefi, M. R. (2022). Efficacy of Care and Antibiotic Use for Chalazia and Hordeola. Eye & contact lens, 48(4), 162–168. https://doi.org/10.1097/ICL.0000000000000859
• 10
  Alsoudi AF, Ton L, Ashraf DC, Idowu OO, Kong AW, Wang L, Kersten RC, Winn BJ, Grob SR, Vagefi MR. Efficacy of Care and Antibiotic Use for Chalazia and Hordeola. Eye Contact Lens. 2022 Apr 1;48(4):162-168. doi: 10.1097/ICL.0000000000000859. PMID: 35296627; PMCID: PMC8931268.
• 11
  Alsoudi, A. F., Ton, L., Ashraf, D. C., Idowu, O. O., Kong, A. W., Wang, L., Kersten, R. C., Winn, B. J., Grob, S. R., & Vagefi, M. R. (2022). Efficacy of Care and Antibiotic Use for Chalazia and Hordeola. Eye & contact lens, 48(4), 162–168. https://doi.org/10.1097/ICL.0000000000000859