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Hordeolum is a complication of the eyelid inflammation, usually caused by a bacterial infection. The bacteria which in most cases causes this infection is called Staphyloccoccus. Hordeolum is one of the most common inflammatory disorders of the eyelid, and it can affect persons of all age groups, although it is more frequent in the younger population. It can be very painful, and in some cases long-lasting. Hordeolum occurs when the eyelid infection affects some of the numerous oil glands of the eyelid. Depending on the type of the affected gland, there are two types of hordeolum: 

  • internal
  • external (also called stye). 

Following is some information on how to recognize and manage different types of a hordeolum.

Although it may not seem so, the eyelids are very complex organs, with numerous anatomical structures, complex physiology, and a lot of space for the development of pathological processes.

Symptoms

Internal hordeolum occurs when the eyelid infection affects so called - Meibomian glands, which are located closer to the internal surface of the eyelids. On the other hand, external hordeolum is caused by the infection of the more superficial glands called “glands of Zeis.”

In both cases, hordeolum is presented as a painful, red, tender lump on the internal or external surface of the eyelid. An internal hordeolum is usually more painful, and it tends to last longer than external. The size of the lump is directly related to the severity of the disease, and it determines the treatment plan. Swelling of the affected eyelid is almost always present to some extent. If the inflammation is significant, inflammatory mediators can produce systemic symptoms, such as increased body temperature, chills, and fever.

Diagnosis

The diagnosis of hordeolum is usually straightforward, and your general practitioner will most probably be able to recognize it and recommend the treatment, based on physical examination.

Additional tests, such as bacteriological tests are performed only when the hordeolum does not respond to standard treatment.

An ophthalmologist can be consulted in cases when the swelling is very pronounced or if the infection starts to spread to the surrounding eye structures.

Treatment

Treatment for both internal and external hordeolum is usually conservative, which means that surgery is performed only if necessary. The disorder can sometimes resolve on its own, without the need for treatment, although that is more common with the external hordeolum. The usual approach includes the application of warm compresses to the affected area, use of corticosteroid and/or antibiotic topical creams, and lid scrubs. In more severe cases, there is a need for the systemic use of antibiotics (oral or even intramuscular). 

Surgical treatment is performed if none of the conservative measures do not help. It usually consists of making a small incision through which the pus can be evacuated from the hordeolum.

During the healing process, keeping good facial hygiene is of great importance to avoid the infection to spread to the surrounding tissues.

The whole process of hordeolum healing should not last more than two weeks. However, in some complicated cases, this inflammation can become chronic, which is then called chronic hordeolum, which requires a combination of surgery and conservative treatment.

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