Hordeolum and Stye in Emergency Medicine
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A hordeolum (ie, stye) is a localized infection or inflammation of the eyelid margin involving hair follicles of the eyelashes (ie, external hordeolum) or meibomian glands (ie, internal hordeolum).
A hordeolum usually is painful, erythematous, and localized. It may produce edema of the entire lid. Purulent material exudes from the eyelash line in external hordeola, while internal hordeola suppurate on the conjunctival surface of eyelid.
A chalazion is a painless granuloma of the meibomian glands. The two entities may be distinguished based on the presence or absence of pain. The remainder of this article focuses on hordeolum.
Staphylococcus aureus is the infectious agent in 90-95% of cases of hordeolum.
An external hordeolum arises from a blockage and infection of Zeiss or Moll sebaceous glands. An internal hordeolum is a secondary infection of meibomian glands in the tarsal plate. Both types can arise as a secondary complication of blepharitis.
Untreated, the disease may spontaneously resolve or it may progress to chronic granulation with formation of a painless mass known as a chalazion. Chalazia can be quite large and can cause visual disturbance by deforming the cornea. Generalized cellulitis of the eyelid may occur if an internal hordeolum is untreated.
Most morbidity is secondary to improper drainage. Proper technique and drainage precautions are described in Treatment.
United States
Exact incidence of the disease is unknown, but it is a common entity.
International
No difference exists between US and international occurrence.
No sexual predilection exists.
A slight increase in incidence is observed in the third to fifth decades of life.
Spontaneous healing is common.
Frequent recurrences are common.
Progression to systemic infection is rare; only a few case reports appear in the current literature.
Instruct patients on proper use of warm compresses and antibiotic use as described above.
For prevention, educate patients about lid hygiene.
Instruct patients not to squeeze a stye, because infection may spread to adjacent tissues.
For patient education resources, see the Eye and Vision Center, as well as Chalazion (Lump in Eyelid) and Sty.
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Michael J Bessette, MD, FACEP Director of Emergency Medicine, Jersey City Medical Center
Michael J Bessette, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Gil Z Shlamovitz, MD, FACEP Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC
Gil Z Shlamovitz, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association
Disclosure: Nothing to disclose.
Robert E O’Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System
Robert E O’Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Heart Association, American Medical Association, National Association of EMS Physicians, Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
Robin R Hemphill, MD, MPH Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine
Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
Hordeolum and Stye in Emergency Medicine
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