2.10 Hordeolum (Sty)

agk’s Library of Common Simple Emergencies

Presentation

The patient complains of redness, swelling, and pain in the eyelid, perhaps at the base of an eyelash (sty or external hordeolum) or deep within the lid (meibomianitis or internal hordeolum, best appreciated with the lid everted) perhaps with conjunctivitis and purulent drainage.

What to do:

• Examine the eye, including visual acuity and inversion of lids (see Conjunctival FB for technique).
• Show patient how to instill antibiotic drops or ointment (e.g., sulfa, tobramycin, erythromycin, gentamycin) into his lower conjunctival sac and apply warm tap water compresses for 10 minutes per hour or 20 minutes four time daily.
• Instruct the patient to return to the ophthalmologist or the ED if the problem is not clearly resolving in two days, or if it gets any worse.
• If the abscess does not spontaneously drain or resolve in two days, you may incise it with the tip of a #11 blade or small needle, with the same follow up instructions.

What not to do:

• Do not miss a periorbital cellulitis, which is a severe infection and requires agressive systemic antibiotic treatment.

Discussion

The terminology of the two types of hordeolum have become confusing. Meibomian glands run vertically, within the tarsal plate, open at tiny puncta along the lid margin, and secrete oil to coat the tear film. The glands of Zeiss and Moll are the sebaceous glands opening into the follicles of the eyelashes. Both can become occluded and superinfected, producing meibomianitis (internal hordeolum) or a sty (external hordeolum). The ED care of both acute infections is the same. A chronic granuloma of the meibomian gland is called a chalazion, will not drain, and requires excision.

Illustration

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES ©
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