Hordeolum

  SIGNS AND SYMPTOMS
Patients will present with an acutely swollen and edematous upper or lower eyelid. Visual function will be normal. There may be an associated conjunctivitis and possibly mucopurulent discharge. The lids will be extremely sensitive to palpation, and there may be an associated pustular, pimple-like lesion at the lid margin or, less commonly, at the dermis.

PATHOPHYSIOLOGY
A hordeolum is a bacterial infection of either the meibomian glands or ciliary glands (the glands of Zeis and Moll). If the latter are involved, the hordeolum is considered external and appears focal in nature. If the deeper meibomian glands are involved, the hordeolum is considered internal and is less circumscribed in appearance. Staphylococcus aureus and Staphylococcus epidermidis are the most likely culprits. Acute and chronic inflammation associated with hordeola, especially if improperly treated, may result in a granulomatous inflammation known as chalazia. If the infection spreads to neighboring glands or other lid tissue anterior to the tarsal plate, it may lead to preseptal cellulitis.

MANAGEMENT
Traditionally, the standard treatment has been topical antibiotic solutions and ointments. Unfortunately, this has virtually no therapeutic benefit. Topical application does not supply enough intra-tissue concentrations of antibiotics to be effective. Oral antibiotic therapy is necessary. If the hordeolum is external, you may drain and lance the lesion (anesthetic is usually unnecessary) or epilate nearby lashes to enhance drainage. Digital expression of purulent material in your office will expedite healing, but is not absolutely necessary. Antibiotic therapy could include dicloxacillin 250mg PO Q6H, erythromycin or tetracycline 250mg PO QID or amoxacillin 500mg PO TID for 10 days. Cold compresses will help to suppress inflammation.

CLINICAL PEARLS

The most common misdiagnosis of hordeola is chalazia. The distinguishing factor is pain upon palpation. If the lesion is not intensely sensitive to palpation, most likely it's a chalazion.
Avoid traditional topical therapies, which are therapeutically ineffective, and begin immediately with oral medications.